1

Presented by Yvonne Dailey CPC CPC-I ALL RIGHTS REVERED

Disclaimer The materials are offered as tools to assist the

participants in understanding their revenue cycle No part of the presentation may be reproduced or transmitted in any form or by any means (graphically electronically or mechanically including photocopying recording or taping) without the expressed written permission of Dailey Billing Services Inc

All Rights Reserved

Introduction Provider Practice as a ldquoBUSINESSrdquo Communication is Key Start of the Revenue Cycle Everyone has a Role and Responsibility Denial Management Timely Filing Guidelines and Corrective Claims Guidelines Getting the Patient Involved ndash Early Using New Technology ndash Offer Multiple Payment Options Using the Internet for Skip Trace Techniques Performing Written as Well as Oral Communication Small Claims vs Collections Agency

All Rights Reserved

2

Keeping The Pulse Alive The practice is a Business

Start off on the right foot

Financial Policy ndash Stick to it Set the rule on getting paid

Set up collection goals ndash weekly monthly quarterly annually

Know your surroundings

Get patients involved early

Offer different methods for payments

Know when to cut your losses

Know who you are contracted with ndash VERY important when scheduling

Medical Billing Process

What is YOUR Role in this Process Role Responsibilities

ReceptionistScheduler Schedules the patientrsquos appointment greets the patient verifies insurance amp eligibility Discusses insurance coverage with the patient

Provider Examines the patient Documents the patientrsquos condition and treatment plan in medical record

Medical Coder Interprets the medical record based on the documentation ndash depending on facility may add modifiers and procedures

3

What is YOUR Role in this Process Role Responsibilities

Charge Entry Clerk Biller Verifies the case information for accuracy for claim submission Submits claims

Payment Clerk Applies all payments received to patient account - THIS INCLUDES ZERO PAYMENT EOBS

Account Representive Researches all denialrejections processes all corrections resolves insurance billing or payment problems and establishes payment plan with patient

What is YOUR Role in this Process

Role Responsibilities

Administrator Generates and reviews reports for supporting the billing process These reports included daily weekly monthly quarterly and yearly tasks

Medical Billing Process Insurance Verification

The First Step ndash First Contact with Patient ndash Cycle Starts The MOST important step in process ndash Most Ignored Provider Network Inform Patient Up front New Patient vs Established Patient No Time Loss of Revenue Identify if prior authorizationprecertification andor

referral are needed ABN The Referring Provider What Questions to Ask

4

Medical Billing Process Insurance Verification Process

Questions to ask Does the patient have a deductible Has it been met Does the patient have co-insurance Whatrsquos the percentage

Does the patient have a co-pay How much is it

Start date and end date of coverage

Medical Billing Process Insurance Verification

Name the Following Carriers

1 W123458759_____________________

2 U410312358______________________

3 NJX3HZN44105___________________

4MEDBBDXE________________________

5 MA123456789_______________________

6123456789A ________________________

YLM81180650________________________

QFT111011236545______________________

Medical Billing Process Patient Demographics

Review intake form to ensure the information is accurate

Did the patient sign the financial policy

Make a copy of the insurance card ndash front and back

Make a copy of patient ID ndash front and back

Are ALL forms signed and dated

Collect co-pay deductible andor co-insurance

Update intake forms annually

Start and end dates for insurance carriers ndash REQUIRE IT

Review your returned mail

Review at each visit ndash review ID also for changes

5

Medical Billing Process CPT amp ICD 9 CODING

The coderrsquos responsibility is to review for accuracy

Never leave money on the table

Medical billing and coding is like a puzzle ndash all pieces must link together accordingly

Medical Necessity

Know your carrier guidelines and policies

Medical Billing Process CPT amp ICD 9 CODING

Letrsquos review the following examples Provider documented Flu shot The flu vaccine can be billed a number of ways Medicare (depending on your Medicare Carrier)

Q0236 ndash Flu Vaccine ( your Q code depends on the ACTUAL vaccine administered to patient) G0008 ndash Administration of Flu Vaccine

To bill a commercial carrier 90658 ndash Flu Vaccine 90471 ndash Administration of vaccine

Changes if it was the FluMist

This is a small sampling as there are multiple vaccine codes for the flu

Medical Billing Process CPT amp ICD 9 CODING

6

Medical Billing Process Charge Entry

Enter all charges

Review BEFORE submission

Based on the providerrsquos documentation

Review for lost revenue (administration supplies etc)

Samples of things to review

NPI referring provider information on set date DOB DOS

Know payer policies for what is billed

Know carrier timely guidelines

Are any modifiers needed

Medical Billing Process Charge Entry

Letrsquos review the sample charge ticket

How many billable charges are there

Is there anything missing

Will it require a modifier

Do you need a referring andor ordering provider

Does it make a difference if this is a Medicare pt or a Commercial pt Why or why not

Now letrsquos look at the 1500 for this claim

Medical Billing Process Charge Entry

7

Medical Billing Process Charge Entry

Medical Billing Process Claim Submission

Review and document your claim submissions

If your clearinghouse allows corrections on the site be sure to correct on your end also

Review your EDI reports daily

Know what reports are needed for appeals andor fighting your timely filing

Know your claim submission file (837 835 997 etc)

Medical Billing Process Payment Posting

All payments must be posted ndash EVEN your ZERO dollar EOBs and even if you are going to work the denialrejection post it

Know your denial codes such as CO50 CO45 PR204 etc

Use notes in your system ndash important

Document all communication with carriers ndash date time and person you spoke to

8

Medical Billing Process Payment Posting

Letrsquos review the following example

Par Dr Amt Billed

Pd at TOS

Carrier payment

Write off amount

Amt to bill pt

Difference

$200 $10 $100

Non Par

$200 $10 $100

Medical Billing Process AR Follow UP

Follow Up - Most important to manage the AR

Must be able to research and know where to search

Insurance Aging

Patient Aging

Work weekly monthly quarterly yearly

Pick up the phone ndash it still works

Document your follow up attempts notes letters phone calls etc

Medical Billing Process Denial Management

In many cases practice denials represent internal errors

Loss of revenue or delayed revenue

Track denials

Train staff on payer policies coding billing (your findings)

Monitor

Make staff members accountable

9

Medical Billing Process Denial Management

Know the difference between a denial and rejection

Letrsquos review denial code CO50

PR27

Which is a rejection and which is a denial

Understand how to read your EOBs

Just because the EOB states to write it off doesnrsquot always mean you write it off

APPEAL APPEAL APPEAL

Medical Billing Process Denial Management

Clearinghouse Dashboards

Gives complete summary (accepted denials)

Overview of your top rejections

Use as training tool

Share your findings with staff and providers

Inform provider not everything gets paid

Medical Billing Process Denial Management

10

Medical Billing Process Denial Management

Medical Billing Process Cost For NOT Working Denials

90 CLAIMS PER DAY AT $90 PER CLAIM = $8100

IF 10 DENIED = $810 IN DENIAL PER DAY

IF ONLY 1 IN 10 DENIALS ARE APPEALED IT =$72900 PER DAY

52 WEEKS X 5 DAYS ndash 20 DAY (VACATIONS AND HOLIDAYS) = 240 WORKING DAYS

240 DAYS X $72900 = $174960 LOST PER YEAR

Medical Billing Process Useful Reports

Practice Analysis

Insurance Aging (90 120 151)

Secondary Aging (medigap claims)

Procedure Analysis

Diagnosis Analysis

Patient Aging

Denial Report

Surgery Report

11

Timely Filing Guidelines Carrier Time Frame

United Health Care 90 Days from date of Service

Oxford 90 Days from Date of Service

Aetna 180 Days from Date of Service

Cigna 90 Days from Date of Service

Cigna Great West 15 months

Medicare 12 months (Calendar )

This will differ if the provider is NON PAR For example Cigna is 180 Days

Proof of Timely Filing Most carriers want your EDI reports to show claims

accepted and acknowledged by Payor

Some Carriers REQUIRE you use their forms to appeal

Itrsquos not enough to have an acceptance from your clearinghouse They want acknowledgement that THEY received it

If you mailed your claims then you should have mailed certified with return receipt

Corrective Claims Guidelines Carrier Time Frame

United Health Care 60 Days from date of remit

Oxford 60 Days from date of remit

Aetna 12 Months from date of remit

Cigna 180 Days from date of remit

Some may require that you use THEIR forms others may allow you to simply write a request Forms may vary depending on state where provider is located Should ALWAYS BE SENT CERTIFIED WITH RETURN RECEIPT Keep a file andor log so you can track

12

Reasons Patients DONrsquoT Pay Job loss reduced income

Emergency situations

Loss of insurance coverage

Hardship

Not understanding insurance plans

Wasnrsquot aware they owed

Killing The Awkward Silence Of Collecting Money

Kill it with kindness

Keep it simple keep it professional be assertive

Offer multiple payment options

Different Type of Collections Letters Financial Policy

Funds Were Paid To Patient

Past Due Notices (30 60 90)

Offering Different Payment Methods

No Payment Received By Carriers

Pre-Existing Clause

Insurance Verification Letter

Financial Hardship

13

The Cost To Collect A Copay Copay

Amount CashCheck

at time of service

Credit Card payment in

office

Billing the patient

Billing the patient TWICE

$2000 $0 ($2000) $96 ($1904) $300 (1700) $600 (1400)

Patient has been billed three times and NEVER Pays

- $2900

Different Payment Options Debit Cards

Credit Cards

Online AUTOMATIC withdrawals from checking or savings

Check

Cash

Via your website

Paypal

Online Bill Payment Merchant accounts now offer ways to pay by credit

card via the internet where the patient feels comfortable putting in their own information For example we use Netdeposit Set up direct payment out of their check savings and or credit card Taken out automatically monthly or bimonthly

( check payment online)

14

The Benefits Of Online Bill Payments Automatic debit from any account type

Recurring payment schedules

View payment history

View future payments

Archived payment receipts

Receipts emailed to both patient and practice

Payment scheduled is also emailed to patient and practice

Online Payment History

GENERAL TRANSACTION VIEW BEGINNING 02042013

Month Checks Ck Amt Credit Cards Credit Amt Total Rev

Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677

Skip Tracing Methods What is Skip Trace

Skip Trace Identifiers

Patientrsquos EXACT full name

Date of Birth or Age

Social Security Numbers

Previous Address ndash Last Known

Driverrsquos License Number

Insurance Policy Numbers

15

Skip Tracing Methods- Let Your Monthly

Statements Do the work For YOU

Use your Postal Service - Ancillary Service Endorsements

Return Service Requested

Temp-Return Service Requested

Address Service Requested

Change Service Requested

NCOA-Link services

Letting Monthly Statements Do The Work For YOU

NCOA-LINK

16

Internet Skip Trace Many different websites to assist you

www411com

wwwuspscom

wwwgooglecom

Other people search sites

The cost vary from $100 to $35000

Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People

Name Age Previous

Cities DOB Phone Address Avg Income

Avg Home

Value Relatives

1

Yvonne D

Dailey

38 Bradenton FL

Oneco FL

Randall T

Dailey (40)

Connie Y

Dailey (70)

Thomas M

Dailey (70)

Constance Y

Dailey (70)

William F

Dailey (36)

2

Yvonne D

Dailey

41

Long Branch

NJ

Albuquerque

NM

Toms River

NJ

Delroy A

Dailey (40)

Bill Dailey

Mr Dailey

3 Yvonne D

Dailey

52

Austin TX

Claremore

OK

Spicewood

TX

Camille

Yvonne

Dailey (52)

Jon Dailey

Perform written as well as oral communications Use the collection letters

Call the patient if over 60 days

Offer a payment plan and stick to it

Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place

2

Keeping The Pulse Alive The practice is a Business

Start off on the right foot

Financial Policy ndash Stick to it Set the rule on getting paid

Set up collection goals ndash weekly monthly quarterly annually

Know your surroundings

Get patients involved early

Offer different methods for payments

Know when to cut your losses

Know who you are contracted with ndash VERY important when scheduling

Medical Billing Process

What is YOUR Role in this Process Role Responsibilities

ReceptionistScheduler Schedules the patientrsquos appointment greets the patient verifies insurance amp eligibility Discusses insurance coverage with the patient

Provider Examines the patient Documents the patientrsquos condition and treatment plan in medical record

Medical Coder Interprets the medical record based on the documentation ndash depending on facility may add modifiers and procedures

3

What is YOUR Role in this Process Role Responsibilities

Charge Entry Clerk Biller Verifies the case information for accuracy for claim submission Submits claims

Payment Clerk Applies all payments received to patient account - THIS INCLUDES ZERO PAYMENT EOBS

Account Representive Researches all denialrejections processes all corrections resolves insurance billing or payment problems and establishes payment plan with patient

What is YOUR Role in this Process

Role Responsibilities

Administrator Generates and reviews reports for supporting the billing process These reports included daily weekly monthly quarterly and yearly tasks

Medical Billing Process Insurance Verification

The First Step ndash First Contact with Patient ndash Cycle Starts The MOST important step in process ndash Most Ignored Provider Network Inform Patient Up front New Patient vs Established Patient No Time Loss of Revenue Identify if prior authorizationprecertification andor

referral are needed ABN The Referring Provider What Questions to Ask

4

Medical Billing Process Insurance Verification Process

Questions to ask Does the patient have a deductible Has it been met Does the patient have co-insurance Whatrsquos the percentage

Does the patient have a co-pay How much is it

Start date and end date of coverage

Medical Billing Process Insurance Verification

Name the Following Carriers

1 W123458759_____________________

2 U410312358______________________

3 NJX3HZN44105___________________

4MEDBBDXE________________________

5 MA123456789_______________________

6123456789A ________________________

YLM81180650________________________

QFT111011236545______________________

Medical Billing Process Patient Demographics

Review intake form to ensure the information is accurate

Did the patient sign the financial policy

Make a copy of the insurance card ndash front and back

Make a copy of patient ID ndash front and back

Are ALL forms signed and dated

Collect co-pay deductible andor co-insurance

Update intake forms annually

Start and end dates for insurance carriers ndash REQUIRE IT

Review your returned mail

Review at each visit ndash review ID also for changes

5

Medical Billing Process CPT amp ICD 9 CODING

The coderrsquos responsibility is to review for accuracy

Never leave money on the table

Medical billing and coding is like a puzzle ndash all pieces must link together accordingly

Medical Necessity

Know your carrier guidelines and policies

Medical Billing Process CPT amp ICD 9 CODING

Letrsquos review the following examples Provider documented Flu shot The flu vaccine can be billed a number of ways Medicare (depending on your Medicare Carrier)

Q0236 ndash Flu Vaccine ( your Q code depends on the ACTUAL vaccine administered to patient) G0008 ndash Administration of Flu Vaccine

To bill a commercial carrier 90658 ndash Flu Vaccine 90471 ndash Administration of vaccine

Changes if it was the FluMist

This is a small sampling as there are multiple vaccine codes for the flu

Medical Billing Process CPT amp ICD 9 CODING

6

Medical Billing Process Charge Entry

Enter all charges

Review BEFORE submission

Based on the providerrsquos documentation

Review for lost revenue (administration supplies etc)

Samples of things to review

NPI referring provider information on set date DOB DOS

Know payer policies for what is billed

Know carrier timely guidelines

Are any modifiers needed

Medical Billing Process Charge Entry

Letrsquos review the sample charge ticket

How many billable charges are there

Is there anything missing

Will it require a modifier

Do you need a referring andor ordering provider

Does it make a difference if this is a Medicare pt or a Commercial pt Why or why not

Now letrsquos look at the 1500 for this claim

Medical Billing Process Charge Entry

7

Medical Billing Process Charge Entry

Medical Billing Process Claim Submission

Review and document your claim submissions

If your clearinghouse allows corrections on the site be sure to correct on your end also

Review your EDI reports daily

Know what reports are needed for appeals andor fighting your timely filing

Know your claim submission file (837 835 997 etc)

Medical Billing Process Payment Posting

All payments must be posted ndash EVEN your ZERO dollar EOBs and even if you are going to work the denialrejection post it

Know your denial codes such as CO50 CO45 PR204 etc

Use notes in your system ndash important

Document all communication with carriers ndash date time and person you spoke to

8

Medical Billing Process Payment Posting

Letrsquos review the following example

Par Dr Amt Billed

Pd at TOS

Carrier payment

Write off amount

Amt to bill pt

Difference

$200 $10 $100

Non Par

$200 $10 $100

Medical Billing Process AR Follow UP

Follow Up - Most important to manage the AR

Must be able to research and know where to search

Insurance Aging

Patient Aging

Work weekly monthly quarterly yearly

Pick up the phone ndash it still works

Document your follow up attempts notes letters phone calls etc

Medical Billing Process Denial Management

In many cases practice denials represent internal errors

Loss of revenue or delayed revenue

Track denials

Train staff on payer policies coding billing (your findings)

Monitor

Make staff members accountable

9

Medical Billing Process Denial Management

Know the difference between a denial and rejection

Letrsquos review denial code CO50

PR27

Which is a rejection and which is a denial

Understand how to read your EOBs

Just because the EOB states to write it off doesnrsquot always mean you write it off

APPEAL APPEAL APPEAL

Medical Billing Process Denial Management

Clearinghouse Dashboards

Gives complete summary (accepted denials)

Overview of your top rejections

Use as training tool

Share your findings with staff and providers

Inform provider not everything gets paid

Medical Billing Process Denial Management

10

Medical Billing Process Denial Management

Medical Billing Process Cost For NOT Working Denials

90 CLAIMS PER DAY AT $90 PER CLAIM = $8100

IF 10 DENIED = $810 IN DENIAL PER DAY

IF ONLY 1 IN 10 DENIALS ARE APPEALED IT =$72900 PER DAY

52 WEEKS X 5 DAYS ndash 20 DAY (VACATIONS AND HOLIDAYS) = 240 WORKING DAYS

240 DAYS X $72900 = $174960 LOST PER YEAR

Medical Billing Process Useful Reports

Practice Analysis

Insurance Aging (90 120 151)

Secondary Aging (medigap claims)

Procedure Analysis

Diagnosis Analysis

Patient Aging

Denial Report

Surgery Report

11

Timely Filing Guidelines Carrier Time Frame

United Health Care 90 Days from date of Service

Oxford 90 Days from Date of Service

Aetna 180 Days from Date of Service

Cigna 90 Days from Date of Service

Cigna Great West 15 months

Medicare 12 months (Calendar )

This will differ if the provider is NON PAR For example Cigna is 180 Days

Proof of Timely Filing Most carriers want your EDI reports to show claims

accepted and acknowledged by Payor

Some Carriers REQUIRE you use their forms to appeal

Itrsquos not enough to have an acceptance from your clearinghouse They want acknowledgement that THEY received it

If you mailed your claims then you should have mailed certified with return receipt

Corrective Claims Guidelines Carrier Time Frame

United Health Care 60 Days from date of remit

Oxford 60 Days from date of remit

Aetna 12 Months from date of remit

Cigna 180 Days from date of remit

Some may require that you use THEIR forms others may allow you to simply write a request Forms may vary depending on state where provider is located Should ALWAYS BE SENT CERTIFIED WITH RETURN RECEIPT Keep a file andor log so you can track

12

Reasons Patients DONrsquoT Pay Job loss reduced income

Emergency situations

Loss of insurance coverage

Hardship

Not understanding insurance plans

Wasnrsquot aware they owed

Killing The Awkward Silence Of Collecting Money

Kill it with kindness

Keep it simple keep it professional be assertive

Offer multiple payment options

Different Type of Collections Letters Financial Policy

Funds Were Paid To Patient

Past Due Notices (30 60 90)

Offering Different Payment Methods

No Payment Received By Carriers

Pre-Existing Clause

Insurance Verification Letter

Financial Hardship

13

The Cost To Collect A Copay Copay

Amount CashCheck

at time of service

Credit Card payment in

office

Billing the patient

Billing the patient TWICE

$2000 $0 ($2000) $96 ($1904) $300 (1700) $600 (1400)

Patient has been billed three times and NEVER Pays

- $2900

Different Payment Options Debit Cards

Credit Cards

Online AUTOMATIC withdrawals from checking or savings

Check

Cash

Via your website

Paypal

Online Bill Payment Merchant accounts now offer ways to pay by credit

card via the internet where the patient feels comfortable putting in their own information For example we use Netdeposit Set up direct payment out of their check savings and or credit card Taken out automatically monthly or bimonthly

( check payment online)

14

The Benefits Of Online Bill Payments Automatic debit from any account type

Recurring payment schedules

View payment history

View future payments

Archived payment receipts

Receipts emailed to both patient and practice

Payment scheduled is also emailed to patient and practice

Online Payment History

GENERAL TRANSACTION VIEW BEGINNING 02042013

Month Checks Ck Amt Credit Cards Credit Amt Total Rev

Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677

Skip Tracing Methods What is Skip Trace

Skip Trace Identifiers

Patientrsquos EXACT full name

Date of Birth or Age

Social Security Numbers

Previous Address ndash Last Known

Driverrsquos License Number

Insurance Policy Numbers

15

Skip Tracing Methods- Let Your Monthly

Statements Do the work For YOU

Use your Postal Service - Ancillary Service Endorsements

Return Service Requested

Temp-Return Service Requested

Address Service Requested

Change Service Requested

NCOA-Link services

Letting Monthly Statements Do The Work For YOU

NCOA-LINK

16

Internet Skip Trace Many different websites to assist you

www411com

wwwuspscom

wwwgooglecom

Other people search sites

The cost vary from $100 to $35000

Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People

Name Age Previous

Cities DOB Phone Address Avg Income

Avg Home

Value Relatives

1

Yvonne D

Dailey

38 Bradenton FL

Oneco FL

Randall T

Dailey (40)

Connie Y

Dailey (70)

Thomas M

Dailey (70)

Constance Y

Dailey (70)

William F

Dailey (36)

2

Yvonne D

Dailey

41

Long Branch

NJ

Albuquerque

NM

Toms River

NJ

Delroy A

Dailey (40)

Bill Dailey

Mr Dailey

3 Yvonne D

Dailey

52

Austin TX

Claremore

OK

Spicewood

TX

Camille

Yvonne

Dailey (52)

Jon Dailey

Perform written as well as oral communications Use the collection letters

Call the patient if over 60 days

Offer a payment plan and stick to it

Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place

3

What is YOUR Role in this Process Role Responsibilities

Charge Entry Clerk Biller Verifies the case information for accuracy for claim submission Submits claims

Payment Clerk Applies all payments received to patient account - THIS INCLUDES ZERO PAYMENT EOBS

Account Representive Researches all denialrejections processes all corrections resolves insurance billing or payment problems and establishes payment plan with patient

What is YOUR Role in this Process

Role Responsibilities

Administrator Generates and reviews reports for supporting the billing process These reports included daily weekly monthly quarterly and yearly tasks

Medical Billing Process Insurance Verification

The First Step ndash First Contact with Patient ndash Cycle Starts The MOST important step in process ndash Most Ignored Provider Network Inform Patient Up front New Patient vs Established Patient No Time Loss of Revenue Identify if prior authorizationprecertification andor

referral are needed ABN The Referring Provider What Questions to Ask

4

Medical Billing Process Insurance Verification Process

Questions to ask Does the patient have a deductible Has it been met Does the patient have co-insurance Whatrsquos the percentage

Does the patient have a co-pay How much is it

Start date and end date of coverage

Medical Billing Process Insurance Verification

Name the Following Carriers

1 W123458759_____________________

2 U410312358______________________

3 NJX3HZN44105___________________

4MEDBBDXE________________________

5 MA123456789_______________________

6123456789A ________________________

YLM81180650________________________

QFT111011236545______________________

Medical Billing Process Patient Demographics

Review intake form to ensure the information is accurate

Did the patient sign the financial policy

Make a copy of the insurance card ndash front and back

Make a copy of patient ID ndash front and back

Are ALL forms signed and dated

Collect co-pay deductible andor co-insurance

Update intake forms annually

Start and end dates for insurance carriers ndash REQUIRE IT

Review your returned mail

Review at each visit ndash review ID also for changes

5

Medical Billing Process CPT amp ICD 9 CODING

The coderrsquos responsibility is to review for accuracy

Never leave money on the table

Medical billing and coding is like a puzzle ndash all pieces must link together accordingly

Medical Necessity

Know your carrier guidelines and policies

Medical Billing Process CPT amp ICD 9 CODING

Letrsquos review the following examples Provider documented Flu shot The flu vaccine can be billed a number of ways Medicare (depending on your Medicare Carrier)

Q0236 ndash Flu Vaccine ( your Q code depends on the ACTUAL vaccine administered to patient) G0008 ndash Administration of Flu Vaccine

To bill a commercial carrier 90658 ndash Flu Vaccine 90471 ndash Administration of vaccine

Changes if it was the FluMist

This is a small sampling as there are multiple vaccine codes for the flu

Medical Billing Process CPT amp ICD 9 CODING

6

Medical Billing Process Charge Entry

Enter all charges

Review BEFORE submission

Based on the providerrsquos documentation

Review for lost revenue (administration supplies etc)

Samples of things to review

NPI referring provider information on set date DOB DOS

Know payer policies for what is billed

Know carrier timely guidelines

Are any modifiers needed

Medical Billing Process Charge Entry

Letrsquos review the sample charge ticket

How many billable charges are there

Is there anything missing

Will it require a modifier

Do you need a referring andor ordering provider

Does it make a difference if this is a Medicare pt or a Commercial pt Why or why not

Now letrsquos look at the 1500 for this claim

Medical Billing Process Charge Entry

7

Medical Billing Process Charge Entry

Medical Billing Process Claim Submission

Review and document your claim submissions

If your clearinghouse allows corrections on the site be sure to correct on your end also

Review your EDI reports daily

Know what reports are needed for appeals andor fighting your timely filing

Know your claim submission file (837 835 997 etc)

Medical Billing Process Payment Posting

All payments must be posted ndash EVEN your ZERO dollar EOBs and even if you are going to work the denialrejection post it

Know your denial codes such as CO50 CO45 PR204 etc

Use notes in your system ndash important

Document all communication with carriers ndash date time and person you spoke to

8

Medical Billing Process Payment Posting

Letrsquos review the following example

Par Dr Amt Billed

Pd at TOS

Carrier payment

Write off amount

Amt to bill pt

Difference

$200 $10 $100

Non Par

$200 $10 $100

Medical Billing Process AR Follow UP

Follow Up - Most important to manage the AR

Must be able to research and know where to search

Insurance Aging

Patient Aging

Work weekly monthly quarterly yearly

Pick up the phone ndash it still works

Document your follow up attempts notes letters phone calls etc

Medical Billing Process Denial Management

In many cases practice denials represent internal errors

Loss of revenue or delayed revenue

Track denials

Train staff on payer policies coding billing (your findings)

Monitor

Make staff members accountable

9

Medical Billing Process Denial Management

Know the difference between a denial and rejection

Letrsquos review denial code CO50

PR27

Which is a rejection and which is a denial

Understand how to read your EOBs

Just because the EOB states to write it off doesnrsquot always mean you write it off

APPEAL APPEAL APPEAL

Medical Billing Process Denial Management

Clearinghouse Dashboards

Gives complete summary (accepted denials)

Overview of your top rejections

Use as training tool

Share your findings with staff and providers

Inform provider not everything gets paid

Medical Billing Process Denial Management

10

Medical Billing Process Denial Management

Medical Billing Process Cost For NOT Working Denials

90 CLAIMS PER DAY AT $90 PER CLAIM = $8100

IF 10 DENIED = $810 IN DENIAL PER DAY

IF ONLY 1 IN 10 DENIALS ARE APPEALED IT =$72900 PER DAY

52 WEEKS X 5 DAYS ndash 20 DAY (VACATIONS AND HOLIDAYS) = 240 WORKING DAYS

240 DAYS X $72900 = $174960 LOST PER YEAR

Medical Billing Process Useful Reports

Practice Analysis

Insurance Aging (90 120 151)

Secondary Aging (medigap claims)

Procedure Analysis

Diagnosis Analysis

Patient Aging

Denial Report

Surgery Report

11

Timely Filing Guidelines Carrier Time Frame

United Health Care 90 Days from date of Service

Oxford 90 Days from Date of Service

Aetna 180 Days from Date of Service

Cigna 90 Days from Date of Service

Cigna Great West 15 months

Medicare 12 months (Calendar )

This will differ if the provider is NON PAR For example Cigna is 180 Days

Proof of Timely Filing Most carriers want your EDI reports to show claims

accepted and acknowledged by Payor

Some Carriers REQUIRE you use their forms to appeal

Itrsquos not enough to have an acceptance from your clearinghouse They want acknowledgement that THEY received it

If you mailed your claims then you should have mailed certified with return receipt

Corrective Claims Guidelines Carrier Time Frame

United Health Care 60 Days from date of remit

Oxford 60 Days from date of remit

Aetna 12 Months from date of remit

Cigna 180 Days from date of remit

Some may require that you use THEIR forms others may allow you to simply write a request Forms may vary depending on state where provider is located Should ALWAYS BE SENT CERTIFIED WITH RETURN RECEIPT Keep a file andor log so you can track

12

Reasons Patients DONrsquoT Pay Job loss reduced income

Emergency situations

Loss of insurance coverage

Hardship

Not understanding insurance plans

Wasnrsquot aware they owed

Killing The Awkward Silence Of Collecting Money

Kill it with kindness

Keep it simple keep it professional be assertive

Offer multiple payment options

Different Type of Collections Letters Financial Policy

Funds Were Paid To Patient

Past Due Notices (30 60 90)

Offering Different Payment Methods

No Payment Received By Carriers

Pre-Existing Clause

Insurance Verification Letter

Financial Hardship

13

The Cost To Collect A Copay Copay

Amount CashCheck

at time of service

Credit Card payment in

office

Billing the patient

Billing the patient TWICE

$2000 $0 ($2000) $96 ($1904) $300 (1700) $600 (1400)

Patient has been billed three times and NEVER Pays

- $2900

Different Payment Options Debit Cards

Credit Cards

Online AUTOMATIC withdrawals from checking or savings

Check

Cash

Via your website

Paypal

Online Bill Payment Merchant accounts now offer ways to pay by credit

card via the internet where the patient feels comfortable putting in their own information For example we use Netdeposit Set up direct payment out of their check savings and or credit card Taken out automatically monthly or bimonthly

( check payment online)

14

The Benefits Of Online Bill Payments Automatic debit from any account type

Recurring payment schedules

View payment history

View future payments

Archived payment receipts

Receipts emailed to both patient and practice

Payment scheduled is also emailed to patient and practice

Online Payment History

GENERAL TRANSACTION VIEW BEGINNING 02042013

Month Checks Ck Amt Credit Cards Credit Amt Total Rev

Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677

Skip Tracing Methods What is Skip Trace

Skip Trace Identifiers

Patientrsquos EXACT full name

Date of Birth or Age

Social Security Numbers

Previous Address ndash Last Known

Driverrsquos License Number

Insurance Policy Numbers

15

Skip Tracing Methods- Let Your Monthly

Statements Do the work For YOU

Use your Postal Service - Ancillary Service Endorsements

Return Service Requested

Temp-Return Service Requested

Address Service Requested

Change Service Requested

NCOA-Link services

Letting Monthly Statements Do The Work For YOU

NCOA-LINK

16

Internet Skip Trace Many different websites to assist you

www411com

wwwuspscom

wwwgooglecom

Other people search sites

The cost vary from $100 to $35000

Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People

Name Age Previous

Cities DOB Phone Address Avg Income

Avg Home

Value Relatives

1

Yvonne D

Dailey

38 Bradenton FL

Oneco FL

Randall T

Dailey (40)

Connie Y

Dailey (70)

Thomas M

Dailey (70)

Constance Y

Dailey (70)

William F

Dailey (36)

2

Yvonne D

Dailey

41

Long Branch

NJ

Albuquerque

NM

Toms River

NJ

Delroy A

Dailey (40)

Bill Dailey

Mr Dailey

3 Yvonne D

Dailey

52

Austin TX

Claremore

OK

Spicewood

TX

Camille

Yvonne

Dailey (52)

Jon Dailey

Perform written as well as oral communications Use the collection letters

Call the patient if over 60 days

Offer a payment plan and stick to it

Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place

4

Medical Billing Process Insurance Verification Process

Questions to ask Does the patient have a deductible Has it been met Does the patient have co-insurance Whatrsquos the percentage

Does the patient have a co-pay How much is it

Start date and end date of coverage

Medical Billing Process Insurance Verification

Name the Following Carriers

1 W123458759_____________________

2 U410312358______________________

3 NJX3HZN44105___________________

4MEDBBDXE________________________

5 MA123456789_______________________

6123456789A ________________________

YLM81180650________________________

QFT111011236545______________________

Medical Billing Process Patient Demographics

Review intake form to ensure the information is accurate

Did the patient sign the financial policy

Make a copy of the insurance card ndash front and back

Make a copy of patient ID ndash front and back

Are ALL forms signed and dated

Collect co-pay deductible andor co-insurance

Update intake forms annually

Start and end dates for insurance carriers ndash REQUIRE IT

Review your returned mail

Review at each visit ndash review ID also for changes

5

Medical Billing Process CPT amp ICD 9 CODING

The coderrsquos responsibility is to review for accuracy

Never leave money on the table

Medical billing and coding is like a puzzle ndash all pieces must link together accordingly

Medical Necessity

Know your carrier guidelines and policies

Medical Billing Process CPT amp ICD 9 CODING

Letrsquos review the following examples Provider documented Flu shot The flu vaccine can be billed a number of ways Medicare (depending on your Medicare Carrier)

Q0236 ndash Flu Vaccine ( your Q code depends on the ACTUAL vaccine administered to patient) G0008 ndash Administration of Flu Vaccine

To bill a commercial carrier 90658 ndash Flu Vaccine 90471 ndash Administration of vaccine

Changes if it was the FluMist

This is a small sampling as there are multiple vaccine codes for the flu

Medical Billing Process CPT amp ICD 9 CODING

6

Medical Billing Process Charge Entry

Enter all charges

Review BEFORE submission

Based on the providerrsquos documentation

Review for lost revenue (administration supplies etc)

Samples of things to review

NPI referring provider information on set date DOB DOS

Know payer policies for what is billed

Know carrier timely guidelines

Are any modifiers needed

Medical Billing Process Charge Entry

Letrsquos review the sample charge ticket

How many billable charges are there

Is there anything missing

Will it require a modifier

Do you need a referring andor ordering provider

Does it make a difference if this is a Medicare pt or a Commercial pt Why or why not

Now letrsquos look at the 1500 for this claim

Medical Billing Process Charge Entry

7

Medical Billing Process Charge Entry

Medical Billing Process Claim Submission

Review and document your claim submissions

If your clearinghouse allows corrections on the site be sure to correct on your end also

Review your EDI reports daily

Know what reports are needed for appeals andor fighting your timely filing

Know your claim submission file (837 835 997 etc)

Medical Billing Process Payment Posting

All payments must be posted ndash EVEN your ZERO dollar EOBs and even if you are going to work the denialrejection post it

Know your denial codes such as CO50 CO45 PR204 etc

Use notes in your system ndash important

Document all communication with carriers ndash date time and person you spoke to

8

Medical Billing Process Payment Posting

Letrsquos review the following example

Par Dr Amt Billed

Pd at TOS

Carrier payment

Write off amount

Amt to bill pt

Difference

$200 $10 $100

Non Par

$200 $10 $100

Medical Billing Process AR Follow UP

Follow Up - Most important to manage the AR

Must be able to research and know where to search

Insurance Aging

Patient Aging

Work weekly monthly quarterly yearly

Pick up the phone ndash it still works

Document your follow up attempts notes letters phone calls etc

Medical Billing Process Denial Management

In many cases practice denials represent internal errors

Loss of revenue or delayed revenue

Track denials

Train staff on payer policies coding billing (your findings)

Monitor

Make staff members accountable

9

Medical Billing Process Denial Management

Know the difference between a denial and rejection

Letrsquos review denial code CO50

PR27

Which is a rejection and which is a denial

Understand how to read your EOBs

Just because the EOB states to write it off doesnrsquot always mean you write it off

APPEAL APPEAL APPEAL

Medical Billing Process Denial Management

Clearinghouse Dashboards

Gives complete summary (accepted denials)

Overview of your top rejections

Use as training tool

Share your findings with staff and providers

Inform provider not everything gets paid

Medical Billing Process Denial Management

10

Medical Billing Process Denial Management

Medical Billing Process Cost For NOT Working Denials

90 CLAIMS PER DAY AT $90 PER CLAIM = $8100

IF 10 DENIED = $810 IN DENIAL PER DAY

IF ONLY 1 IN 10 DENIALS ARE APPEALED IT =$72900 PER DAY

52 WEEKS X 5 DAYS ndash 20 DAY (VACATIONS AND HOLIDAYS) = 240 WORKING DAYS

240 DAYS X $72900 = $174960 LOST PER YEAR

Medical Billing Process Useful Reports

Practice Analysis

Insurance Aging (90 120 151)

Secondary Aging (medigap claims)

Procedure Analysis

Diagnosis Analysis

Patient Aging

Denial Report

Surgery Report

11

Timely Filing Guidelines Carrier Time Frame

United Health Care 90 Days from date of Service

Oxford 90 Days from Date of Service

Aetna 180 Days from Date of Service

Cigna 90 Days from Date of Service

Cigna Great West 15 months

Medicare 12 months (Calendar )

This will differ if the provider is NON PAR For example Cigna is 180 Days

Proof of Timely Filing Most carriers want your EDI reports to show claims

accepted and acknowledged by Payor

Some Carriers REQUIRE you use their forms to appeal

Itrsquos not enough to have an acceptance from your clearinghouse They want acknowledgement that THEY received it

If you mailed your claims then you should have mailed certified with return receipt

Corrective Claims Guidelines Carrier Time Frame

United Health Care 60 Days from date of remit

Oxford 60 Days from date of remit

Aetna 12 Months from date of remit

Cigna 180 Days from date of remit

Some may require that you use THEIR forms others may allow you to simply write a request Forms may vary depending on state where provider is located Should ALWAYS BE SENT CERTIFIED WITH RETURN RECEIPT Keep a file andor log so you can track

12

Reasons Patients DONrsquoT Pay Job loss reduced income

Emergency situations

Loss of insurance coverage

Hardship

Not understanding insurance plans

Wasnrsquot aware they owed

Killing The Awkward Silence Of Collecting Money

Kill it with kindness

Keep it simple keep it professional be assertive

Offer multiple payment options

Different Type of Collections Letters Financial Policy

Funds Were Paid To Patient

Past Due Notices (30 60 90)

Offering Different Payment Methods

No Payment Received By Carriers

Pre-Existing Clause

Insurance Verification Letter

Financial Hardship

13

The Cost To Collect A Copay Copay

Amount CashCheck

at time of service

Credit Card payment in

office

Billing the patient

Billing the patient TWICE

$2000 $0 ($2000) $96 ($1904) $300 (1700) $600 (1400)

Patient has been billed three times and NEVER Pays

- $2900

Different Payment Options Debit Cards

Credit Cards

Online AUTOMATIC withdrawals from checking or savings

Check

Cash

Via your website

Paypal

Online Bill Payment Merchant accounts now offer ways to pay by credit

card via the internet where the patient feels comfortable putting in their own information For example we use Netdeposit Set up direct payment out of their check savings and or credit card Taken out automatically monthly or bimonthly

( check payment online)

14

The Benefits Of Online Bill Payments Automatic debit from any account type

Recurring payment schedules

View payment history

View future payments

Archived payment receipts

Receipts emailed to both patient and practice

Payment scheduled is also emailed to patient and practice

Online Payment History

GENERAL TRANSACTION VIEW BEGINNING 02042013

Month Checks Ck Amt Credit Cards Credit Amt Total Rev

Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677

Skip Tracing Methods What is Skip Trace

Skip Trace Identifiers

Patientrsquos EXACT full name

Date of Birth or Age

Social Security Numbers

Previous Address ndash Last Known

Driverrsquos License Number

Insurance Policy Numbers

15

Skip Tracing Methods- Let Your Monthly

Statements Do the work For YOU

Use your Postal Service - Ancillary Service Endorsements

Return Service Requested

Temp-Return Service Requested

Address Service Requested

Change Service Requested

NCOA-Link services

Letting Monthly Statements Do The Work For YOU

NCOA-LINK

16

Internet Skip Trace Many different websites to assist you

www411com

wwwuspscom

wwwgooglecom

Other people search sites

The cost vary from $100 to $35000

Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People

Name Age Previous

Cities DOB Phone Address Avg Income

Avg Home

Value Relatives

1

Yvonne D

Dailey

38 Bradenton FL

Oneco FL

Randall T

Dailey (40)

Connie Y

Dailey (70)

Thomas M

Dailey (70)

Constance Y

Dailey (70)

William F

Dailey (36)

2

Yvonne D

Dailey

41

Long Branch

NJ

Albuquerque

NM

Toms River

NJ

Delroy A

Dailey (40)

Bill Dailey

Mr Dailey

3 Yvonne D

Dailey

52

Austin TX

Claremore

OK

Spicewood

TX

Camille

Yvonne

Dailey (52)

Jon Dailey

Perform written as well as oral communications Use the collection letters

Call the patient if over 60 days

Offer a payment plan and stick to it

Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place

5

Medical Billing Process CPT amp ICD 9 CODING

The coderrsquos responsibility is to review for accuracy

Never leave money on the table

Medical billing and coding is like a puzzle ndash all pieces must link together accordingly

Medical Necessity

Know your carrier guidelines and policies

Medical Billing Process CPT amp ICD 9 CODING

Letrsquos review the following examples Provider documented Flu shot The flu vaccine can be billed a number of ways Medicare (depending on your Medicare Carrier)

Q0236 ndash Flu Vaccine ( your Q code depends on the ACTUAL vaccine administered to patient) G0008 ndash Administration of Flu Vaccine

To bill a commercial carrier 90658 ndash Flu Vaccine 90471 ndash Administration of vaccine

Changes if it was the FluMist

This is a small sampling as there are multiple vaccine codes for the flu

Medical Billing Process CPT amp ICD 9 CODING

6

Medical Billing Process Charge Entry

Enter all charges

Review BEFORE submission

Based on the providerrsquos documentation

Review for lost revenue (administration supplies etc)

Samples of things to review

NPI referring provider information on set date DOB DOS

Know payer policies for what is billed

Know carrier timely guidelines

Are any modifiers needed

Medical Billing Process Charge Entry

Letrsquos review the sample charge ticket

How many billable charges are there

Is there anything missing

Will it require a modifier

Do you need a referring andor ordering provider

Does it make a difference if this is a Medicare pt or a Commercial pt Why or why not

Now letrsquos look at the 1500 for this claim

Medical Billing Process Charge Entry

7

Medical Billing Process Charge Entry

Medical Billing Process Claim Submission

Review and document your claim submissions

If your clearinghouse allows corrections on the site be sure to correct on your end also

Review your EDI reports daily

Know what reports are needed for appeals andor fighting your timely filing

Know your claim submission file (837 835 997 etc)

Medical Billing Process Payment Posting

All payments must be posted ndash EVEN your ZERO dollar EOBs and even if you are going to work the denialrejection post it

Know your denial codes such as CO50 CO45 PR204 etc

Use notes in your system ndash important

Document all communication with carriers ndash date time and person you spoke to

8

Medical Billing Process Payment Posting

Letrsquos review the following example

Par Dr Amt Billed

Pd at TOS

Carrier payment

Write off amount

Amt to bill pt

Difference

$200 $10 $100

Non Par

$200 $10 $100

Medical Billing Process AR Follow UP

Follow Up - Most important to manage the AR

Must be able to research and know where to search

Insurance Aging

Patient Aging

Work weekly monthly quarterly yearly

Pick up the phone ndash it still works

Document your follow up attempts notes letters phone calls etc

Medical Billing Process Denial Management

In many cases practice denials represent internal errors

Loss of revenue or delayed revenue

Track denials

Train staff on payer policies coding billing (your findings)

Monitor

Make staff members accountable

9

Medical Billing Process Denial Management

Know the difference between a denial and rejection

Letrsquos review denial code CO50

PR27

Which is a rejection and which is a denial

Understand how to read your EOBs

Just because the EOB states to write it off doesnrsquot always mean you write it off

APPEAL APPEAL APPEAL

Medical Billing Process Denial Management

Clearinghouse Dashboards

Gives complete summary (accepted denials)

Overview of your top rejections

Use as training tool

Share your findings with staff and providers

Inform provider not everything gets paid

Medical Billing Process Denial Management

10

Medical Billing Process Denial Management

Medical Billing Process Cost For NOT Working Denials

90 CLAIMS PER DAY AT $90 PER CLAIM = $8100

IF 10 DENIED = $810 IN DENIAL PER DAY

IF ONLY 1 IN 10 DENIALS ARE APPEALED IT =$72900 PER DAY

52 WEEKS X 5 DAYS ndash 20 DAY (VACATIONS AND HOLIDAYS) = 240 WORKING DAYS

240 DAYS X $72900 = $174960 LOST PER YEAR

Medical Billing Process Useful Reports

Practice Analysis

Insurance Aging (90 120 151)

Secondary Aging (medigap claims)

Procedure Analysis

Diagnosis Analysis

Patient Aging

Denial Report

Surgery Report

11

Timely Filing Guidelines Carrier Time Frame

United Health Care 90 Days from date of Service

Oxford 90 Days from Date of Service

Aetna 180 Days from Date of Service

Cigna 90 Days from Date of Service

Cigna Great West 15 months

Medicare 12 months (Calendar )

This will differ if the provider is NON PAR For example Cigna is 180 Days

Proof of Timely Filing Most carriers want your EDI reports to show claims

accepted and acknowledged by Payor

Some Carriers REQUIRE you use their forms to appeal

Itrsquos not enough to have an acceptance from your clearinghouse They want acknowledgement that THEY received it

If you mailed your claims then you should have mailed certified with return receipt

Corrective Claims Guidelines Carrier Time Frame

United Health Care 60 Days from date of remit

Oxford 60 Days from date of remit

Aetna 12 Months from date of remit

Cigna 180 Days from date of remit

Some may require that you use THEIR forms others may allow you to simply write a request Forms may vary depending on state where provider is located Should ALWAYS BE SENT CERTIFIED WITH RETURN RECEIPT Keep a file andor log so you can track

12

Reasons Patients DONrsquoT Pay Job loss reduced income

Emergency situations

Loss of insurance coverage

Hardship

Not understanding insurance plans

Wasnrsquot aware they owed

Killing The Awkward Silence Of Collecting Money

Kill it with kindness

Keep it simple keep it professional be assertive

Offer multiple payment options

Different Type of Collections Letters Financial Policy

Funds Were Paid To Patient

Past Due Notices (30 60 90)

Offering Different Payment Methods

No Payment Received By Carriers

Pre-Existing Clause

Insurance Verification Letter

Financial Hardship

13

The Cost To Collect A Copay Copay

Amount CashCheck

at time of service

Credit Card payment in

office

Billing the patient

Billing the patient TWICE

$2000 $0 ($2000) $96 ($1904) $300 (1700) $600 (1400)

Patient has been billed three times and NEVER Pays

- $2900

Different Payment Options Debit Cards

Credit Cards

Online AUTOMATIC withdrawals from checking or savings

Check

Cash

Via your website

Paypal

Online Bill Payment Merchant accounts now offer ways to pay by credit

card via the internet where the patient feels comfortable putting in their own information For example we use Netdeposit Set up direct payment out of their check savings and or credit card Taken out automatically monthly or bimonthly

( check payment online)

14

The Benefits Of Online Bill Payments Automatic debit from any account type

Recurring payment schedules

View payment history

View future payments

Archived payment receipts

Receipts emailed to both patient and practice

Payment scheduled is also emailed to patient and practice

Online Payment History

GENERAL TRANSACTION VIEW BEGINNING 02042013

Month Checks Ck Amt Credit Cards Credit Amt Total Rev

Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677

Skip Tracing Methods What is Skip Trace

Skip Trace Identifiers

Patientrsquos EXACT full name

Date of Birth or Age

Social Security Numbers

Previous Address ndash Last Known

Driverrsquos License Number

Insurance Policy Numbers

15

Skip Tracing Methods- Let Your Monthly

Statements Do the work For YOU

Use your Postal Service - Ancillary Service Endorsements

Return Service Requested

Temp-Return Service Requested

Address Service Requested

Change Service Requested

NCOA-Link services

Letting Monthly Statements Do The Work For YOU

NCOA-LINK

16

Internet Skip Trace Many different websites to assist you

www411com

wwwuspscom

wwwgooglecom

Other people search sites

The cost vary from $100 to $35000

Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People

Name Age Previous

Cities DOB Phone Address Avg Income

Avg Home

Value Relatives

1

Yvonne D

Dailey

38 Bradenton FL

Oneco FL

Randall T

Dailey (40)

Connie Y

Dailey (70)

Thomas M

Dailey (70)

Constance Y

Dailey (70)

William F

Dailey (36)

2

Yvonne D

Dailey

41

Long Branch

NJ

Albuquerque

NM

Toms River

NJ

Delroy A

Dailey (40)

Bill Dailey

Mr Dailey

3 Yvonne D

Dailey

52

Austin TX

Claremore

OK

Spicewood

TX

Camille

Yvonne

Dailey (52)

Jon Dailey

Perform written as well as oral communications Use the collection letters

Call the patient if over 60 days

Offer a payment plan and stick to it

Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place

6

Medical Billing Process Charge Entry

Enter all charges

Review BEFORE submission

Based on the providerrsquos documentation

Review for lost revenue (administration supplies etc)

Samples of things to review

NPI referring provider information on set date DOB DOS

Know payer policies for what is billed

Know carrier timely guidelines

Are any modifiers needed

Medical Billing Process Charge Entry

Letrsquos review the sample charge ticket

How many billable charges are there

Is there anything missing

Will it require a modifier

Do you need a referring andor ordering provider

Does it make a difference if this is a Medicare pt or a Commercial pt Why or why not

Now letrsquos look at the 1500 for this claim

Medical Billing Process Charge Entry

7

Medical Billing Process Charge Entry

Medical Billing Process Claim Submission

Review and document your claim submissions

If your clearinghouse allows corrections on the site be sure to correct on your end also

Review your EDI reports daily

Know what reports are needed for appeals andor fighting your timely filing

Know your claim submission file (837 835 997 etc)

Medical Billing Process Payment Posting

All payments must be posted ndash EVEN your ZERO dollar EOBs and even if you are going to work the denialrejection post it

Know your denial codes such as CO50 CO45 PR204 etc

Use notes in your system ndash important

Document all communication with carriers ndash date time and person you spoke to

8

Medical Billing Process Payment Posting

Letrsquos review the following example

Par Dr Amt Billed

Pd at TOS

Carrier payment

Write off amount

Amt to bill pt

Difference

$200 $10 $100

Non Par

$200 $10 $100

Medical Billing Process AR Follow UP

Follow Up - Most important to manage the AR

Must be able to research and know where to search

Insurance Aging

Patient Aging

Work weekly monthly quarterly yearly

Pick up the phone ndash it still works

Document your follow up attempts notes letters phone calls etc

Medical Billing Process Denial Management

In many cases practice denials represent internal errors

Loss of revenue or delayed revenue

Track denials

Train staff on payer policies coding billing (your findings)

Monitor

Make staff members accountable

9

Medical Billing Process Denial Management

Know the difference between a denial and rejection

Letrsquos review denial code CO50

PR27

Which is a rejection and which is a denial

Understand how to read your EOBs

Just because the EOB states to write it off doesnrsquot always mean you write it off

APPEAL APPEAL APPEAL

Medical Billing Process Denial Management

Clearinghouse Dashboards

Gives complete summary (accepted denials)

Overview of your top rejections

Use as training tool

Share your findings with staff and providers

Inform provider not everything gets paid

Medical Billing Process Denial Management

10

Medical Billing Process Denial Management

Medical Billing Process Cost For NOT Working Denials

90 CLAIMS PER DAY AT $90 PER CLAIM = $8100

IF 10 DENIED = $810 IN DENIAL PER DAY

IF ONLY 1 IN 10 DENIALS ARE APPEALED IT =$72900 PER DAY

52 WEEKS X 5 DAYS ndash 20 DAY (VACATIONS AND HOLIDAYS) = 240 WORKING DAYS

240 DAYS X $72900 = $174960 LOST PER YEAR

Medical Billing Process Useful Reports

Practice Analysis

Insurance Aging (90 120 151)

Secondary Aging (medigap claims)

Procedure Analysis

Diagnosis Analysis

Patient Aging

Denial Report

Surgery Report

11

Timely Filing Guidelines Carrier Time Frame

United Health Care 90 Days from date of Service

Oxford 90 Days from Date of Service

Aetna 180 Days from Date of Service

Cigna 90 Days from Date of Service

Cigna Great West 15 months

Medicare 12 months (Calendar )

This will differ if the provider is NON PAR For example Cigna is 180 Days

Proof of Timely Filing Most carriers want your EDI reports to show claims

accepted and acknowledged by Payor

Some Carriers REQUIRE you use their forms to appeal

Itrsquos not enough to have an acceptance from your clearinghouse They want acknowledgement that THEY received it

If you mailed your claims then you should have mailed certified with return receipt

Corrective Claims Guidelines Carrier Time Frame

United Health Care 60 Days from date of remit

Oxford 60 Days from date of remit

Aetna 12 Months from date of remit

Cigna 180 Days from date of remit

Some may require that you use THEIR forms others may allow you to simply write a request Forms may vary depending on state where provider is located Should ALWAYS BE SENT CERTIFIED WITH RETURN RECEIPT Keep a file andor log so you can track

12

Reasons Patients DONrsquoT Pay Job loss reduced income

Emergency situations

Loss of insurance coverage

Hardship

Not understanding insurance plans

Wasnrsquot aware they owed

Killing The Awkward Silence Of Collecting Money

Kill it with kindness

Keep it simple keep it professional be assertive

Offer multiple payment options

Different Type of Collections Letters Financial Policy

Funds Were Paid To Patient

Past Due Notices (30 60 90)

Offering Different Payment Methods

No Payment Received By Carriers

Pre-Existing Clause

Insurance Verification Letter

Financial Hardship

13

The Cost To Collect A Copay Copay

Amount CashCheck

at time of service

Credit Card payment in

office

Billing the patient

Billing the patient TWICE

$2000 $0 ($2000) $96 ($1904) $300 (1700) $600 (1400)

Patient has been billed three times and NEVER Pays

- $2900

Different Payment Options Debit Cards

Credit Cards

Online AUTOMATIC withdrawals from checking or savings

Check

Cash

Via your website

Paypal

Online Bill Payment Merchant accounts now offer ways to pay by credit

card via the internet where the patient feels comfortable putting in their own information For example we use Netdeposit Set up direct payment out of their check savings and or credit card Taken out automatically monthly or bimonthly

( check payment online)

14

The Benefits Of Online Bill Payments Automatic debit from any account type

Recurring payment schedules

View payment history

View future payments

Archived payment receipts

Receipts emailed to both patient and practice

Payment scheduled is also emailed to patient and practice

Online Payment History

GENERAL TRANSACTION VIEW BEGINNING 02042013

Month Checks Ck Amt Credit Cards Credit Amt Total Rev

Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677

Skip Tracing Methods What is Skip Trace

Skip Trace Identifiers

Patientrsquos EXACT full name

Date of Birth or Age

Social Security Numbers

Previous Address ndash Last Known

Driverrsquos License Number

Insurance Policy Numbers

15

Skip Tracing Methods- Let Your Monthly

Statements Do the work For YOU

Use your Postal Service - Ancillary Service Endorsements

Return Service Requested

Temp-Return Service Requested

Address Service Requested

Change Service Requested

NCOA-Link services

Letting Monthly Statements Do The Work For YOU

NCOA-LINK

16

Internet Skip Trace Many different websites to assist you

www411com

wwwuspscom

wwwgooglecom

Other people search sites

The cost vary from $100 to $35000

Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People

Name Age Previous

Cities DOB Phone Address Avg Income

Avg Home

Value Relatives

1

Yvonne D

Dailey

38 Bradenton FL

Oneco FL

Randall T

Dailey (40)

Connie Y

Dailey (70)

Thomas M

Dailey (70)

Constance Y

Dailey (70)

William F

Dailey (36)

2

Yvonne D

Dailey

41

Long Branch

NJ

Albuquerque

NM

Toms River

NJ

Delroy A

Dailey (40)

Bill Dailey

Mr Dailey

3 Yvonne D

Dailey

52

Austin TX

Claremore

OK

Spicewood

TX

Camille

Yvonne

Dailey (52)

Jon Dailey

Perform written as well as oral communications Use the collection letters

Call the patient if over 60 days

Offer a payment plan and stick to it

Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place

7

Medical Billing Process Charge Entry

Medical Billing Process Claim Submission

Review and document your claim submissions

If your clearinghouse allows corrections on the site be sure to correct on your end also

Review your EDI reports daily

Know what reports are needed for appeals andor fighting your timely filing

Know your claim submission file (837 835 997 etc)

Medical Billing Process Payment Posting

All payments must be posted ndash EVEN your ZERO dollar EOBs and even if you are going to work the denialrejection post it

Know your denial codes such as CO50 CO45 PR204 etc

Use notes in your system ndash important

Document all communication with carriers ndash date time and person you spoke to

8

Medical Billing Process Payment Posting

Letrsquos review the following example

Par Dr Amt Billed

Pd at TOS

Carrier payment

Write off amount

Amt to bill pt

Difference

$200 $10 $100

Non Par

$200 $10 $100

Medical Billing Process AR Follow UP

Follow Up - Most important to manage the AR

Must be able to research and know where to search

Insurance Aging

Patient Aging

Work weekly monthly quarterly yearly

Pick up the phone ndash it still works

Document your follow up attempts notes letters phone calls etc

Medical Billing Process Denial Management

In many cases practice denials represent internal errors

Loss of revenue or delayed revenue

Track denials

Train staff on payer policies coding billing (your findings)

Monitor

Make staff members accountable

9

Medical Billing Process Denial Management

Know the difference between a denial and rejection

Letrsquos review denial code CO50

PR27

Which is a rejection and which is a denial

Understand how to read your EOBs

Just because the EOB states to write it off doesnrsquot always mean you write it off

APPEAL APPEAL APPEAL

Medical Billing Process Denial Management

Clearinghouse Dashboards

Gives complete summary (accepted denials)

Overview of your top rejections

Use as training tool

Share your findings with staff and providers

Inform provider not everything gets paid

Medical Billing Process Denial Management

10

Medical Billing Process Denial Management

Medical Billing Process Cost For NOT Working Denials

90 CLAIMS PER DAY AT $90 PER CLAIM = $8100

IF 10 DENIED = $810 IN DENIAL PER DAY

IF ONLY 1 IN 10 DENIALS ARE APPEALED IT =$72900 PER DAY

52 WEEKS X 5 DAYS ndash 20 DAY (VACATIONS AND HOLIDAYS) = 240 WORKING DAYS

240 DAYS X $72900 = $174960 LOST PER YEAR

Medical Billing Process Useful Reports

Practice Analysis

Insurance Aging (90 120 151)

Secondary Aging (medigap claims)

Procedure Analysis

Diagnosis Analysis

Patient Aging

Denial Report

Surgery Report

11

Timely Filing Guidelines Carrier Time Frame

United Health Care 90 Days from date of Service

Oxford 90 Days from Date of Service

Aetna 180 Days from Date of Service

Cigna 90 Days from Date of Service

Cigna Great West 15 months

Medicare 12 months (Calendar )

This will differ if the provider is NON PAR For example Cigna is 180 Days

Proof of Timely Filing Most carriers want your EDI reports to show claims

accepted and acknowledged by Payor

Some Carriers REQUIRE you use their forms to appeal

Itrsquos not enough to have an acceptance from your clearinghouse They want acknowledgement that THEY received it

If you mailed your claims then you should have mailed certified with return receipt

Corrective Claims Guidelines Carrier Time Frame

United Health Care 60 Days from date of remit

Oxford 60 Days from date of remit

Aetna 12 Months from date of remit

Cigna 180 Days from date of remit

Some may require that you use THEIR forms others may allow you to simply write a request Forms may vary depending on state where provider is located Should ALWAYS BE SENT CERTIFIED WITH RETURN RECEIPT Keep a file andor log so you can track

12

Reasons Patients DONrsquoT Pay Job loss reduced income

Emergency situations

Loss of insurance coverage

Hardship

Not understanding insurance plans

Wasnrsquot aware they owed

Killing The Awkward Silence Of Collecting Money

Kill it with kindness

Keep it simple keep it professional be assertive

Offer multiple payment options

Different Type of Collections Letters Financial Policy

Funds Were Paid To Patient

Past Due Notices (30 60 90)

Offering Different Payment Methods

No Payment Received By Carriers

Pre-Existing Clause

Insurance Verification Letter

Financial Hardship

13

The Cost To Collect A Copay Copay

Amount CashCheck

at time of service

Credit Card payment in

office

Billing the patient

Billing the patient TWICE

$2000 $0 ($2000) $96 ($1904) $300 (1700) $600 (1400)

Patient has been billed three times and NEVER Pays

- $2900

Different Payment Options Debit Cards

Credit Cards

Online AUTOMATIC withdrawals from checking or savings

Check

Cash

Via your website

Paypal

Online Bill Payment Merchant accounts now offer ways to pay by credit

card via the internet where the patient feels comfortable putting in their own information For example we use Netdeposit Set up direct payment out of their check savings and or credit card Taken out automatically monthly or bimonthly

( check payment online)

14

The Benefits Of Online Bill Payments Automatic debit from any account type

Recurring payment schedules

View payment history

View future payments

Archived payment receipts

Receipts emailed to both patient and practice

Payment scheduled is also emailed to patient and practice

Online Payment History

GENERAL TRANSACTION VIEW BEGINNING 02042013

Month Checks Ck Amt Credit Cards Credit Amt Total Rev

Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677

Skip Tracing Methods What is Skip Trace

Skip Trace Identifiers

Patientrsquos EXACT full name

Date of Birth or Age

Social Security Numbers

Previous Address ndash Last Known

Driverrsquos License Number

Insurance Policy Numbers

15

Skip Tracing Methods- Let Your Monthly

Statements Do the work For YOU

Use your Postal Service - Ancillary Service Endorsements

Return Service Requested

Temp-Return Service Requested

Address Service Requested

Change Service Requested

NCOA-Link services

Letting Monthly Statements Do The Work For YOU

NCOA-LINK

16

Internet Skip Trace Many different websites to assist you

www411com

wwwuspscom

wwwgooglecom

Other people search sites

The cost vary from $100 to $35000

Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People

Name Age Previous

Cities DOB Phone Address Avg Income

Avg Home

Value Relatives

1

Yvonne D

Dailey

38 Bradenton FL

Oneco FL

Randall T

Dailey (40)

Connie Y

Dailey (70)

Thomas M

Dailey (70)

Constance Y

Dailey (70)

William F

Dailey (36)

2

Yvonne D

Dailey

41

Long Branch

NJ

Albuquerque

NM

Toms River

NJ

Delroy A

Dailey (40)

Bill Dailey

Mr Dailey

3 Yvonne D

Dailey

52

Austin TX

Claremore

OK

Spicewood

TX

Camille

Yvonne

Dailey (52)

Jon Dailey

Perform written as well as oral communications Use the collection letters

Call the patient if over 60 days

Offer a payment plan and stick to it

Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place

8

Medical Billing Process Payment Posting

Letrsquos review the following example

Par Dr Amt Billed

Pd at TOS

Carrier payment

Write off amount

Amt to bill pt

Difference

$200 $10 $100

Non Par

$200 $10 $100

Medical Billing Process AR Follow UP

Follow Up - Most important to manage the AR

Must be able to research and know where to search

Insurance Aging

Patient Aging

Work weekly monthly quarterly yearly

Pick up the phone ndash it still works

Document your follow up attempts notes letters phone calls etc

Medical Billing Process Denial Management

In many cases practice denials represent internal errors

Loss of revenue or delayed revenue

Track denials

Train staff on payer policies coding billing (your findings)

Monitor

Make staff members accountable

9

Medical Billing Process Denial Management

Know the difference between a denial and rejection

Letrsquos review denial code CO50

PR27

Which is a rejection and which is a denial

Understand how to read your EOBs

Just because the EOB states to write it off doesnrsquot always mean you write it off

APPEAL APPEAL APPEAL

Medical Billing Process Denial Management

Clearinghouse Dashboards

Gives complete summary (accepted denials)

Overview of your top rejections

Use as training tool

Share your findings with staff and providers

Inform provider not everything gets paid

Medical Billing Process Denial Management

10

Medical Billing Process Denial Management

Medical Billing Process Cost For NOT Working Denials

90 CLAIMS PER DAY AT $90 PER CLAIM = $8100

IF 10 DENIED = $810 IN DENIAL PER DAY

IF ONLY 1 IN 10 DENIALS ARE APPEALED IT =$72900 PER DAY

52 WEEKS X 5 DAYS ndash 20 DAY (VACATIONS AND HOLIDAYS) = 240 WORKING DAYS

240 DAYS X $72900 = $174960 LOST PER YEAR

Medical Billing Process Useful Reports

Practice Analysis

Insurance Aging (90 120 151)

Secondary Aging (medigap claims)

Procedure Analysis

Diagnosis Analysis

Patient Aging

Denial Report

Surgery Report

11

Timely Filing Guidelines Carrier Time Frame

United Health Care 90 Days from date of Service

Oxford 90 Days from Date of Service

Aetna 180 Days from Date of Service

Cigna 90 Days from Date of Service

Cigna Great West 15 months

Medicare 12 months (Calendar )

This will differ if the provider is NON PAR For example Cigna is 180 Days

Proof of Timely Filing Most carriers want your EDI reports to show claims

accepted and acknowledged by Payor

Some Carriers REQUIRE you use their forms to appeal

Itrsquos not enough to have an acceptance from your clearinghouse They want acknowledgement that THEY received it

If you mailed your claims then you should have mailed certified with return receipt

Corrective Claims Guidelines Carrier Time Frame

United Health Care 60 Days from date of remit

Oxford 60 Days from date of remit

Aetna 12 Months from date of remit

Cigna 180 Days from date of remit

Some may require that you use THEIR forms others may allow you to simply write a request Forms may vary depending on state where provider is located Should ALWAYS BE SENT CERTIFIED WITH RETURN RECEIPT Keep a file andor log so you can track

12

Reasons Patients DONrsquoT Pay Job loss reduced income

Emergency situations

Loss of insurance coverage

Hardship

Not understanding insurance plans

Wasnrsquot aware they owed

Killing The Awkward Silence Of Collecting Money

Kill it with kindness

Keep it simple keep it professional be assertive

Offer multiple payment options

Different Type of Collections Letters Financial Policy

Funds Were Paid To Patient

Past Due Notices (30 60 90)

Offering Different Payment Methods

No Payment Received By Carriers

Pre-Existing Clause

Insurance Verification Letter

Financial Hardship

13

The Cost To Collect A Copay Copay

Amount CashCheck

at time of service

Credit Card payment in

office

Billing the patient

Billing the patient TWICE

$2000 $0 ($2000) $96 ($1904) $300 (1700) $600 (1400)

Patient has been billed three times and NEVER Pays

- $2900

Different Payment Options Debit Cards

Credit Cards

Online AUTOMATIC withdrawals from checking or savings

Check

Cash

Via your website

Paypal

Online Bill Payment Merchant accounts now offer ways to pay by credit

card via the internet where the patient feels comfortable putting in their own information For example we use Netdeposit Set up direct payment out of their check savings and or credit card Taken out automatically monthly or bimonthly

( check payment online)

14

The Benefits Of Online Bill Payments Automatic debit from any account type

Recurring payment schedules

View payment history

View future payments

Archived payment receipts

Receipts emailed to both patient and practice

Payment scheduled is also emailed to patient and practice

Online Payment History

GENERAL TRANSACTION VIEW BEGINNING 02042013

Month Checks Ck Amt Credit Cards Credit Amt Total Rev

Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677

Skip Tracing Methods What is Skip Trace

Skip Trace Identifiers

Patientrsquos EXACT full name

Date of Birth or Age

Social Security Numbers

Previous Address ndash Last Known

Driverrsquos License Number

Insurance Policy Numbers

15

Skip Tracing Methods- Let Your Monthly

Statements Do the work For YOU

Use your Postal Service - Ancillary Service Endorsements

Return Service Requested

Temp-Return Service Requested

Address Service Requested

Change Service Requested

NCOA-Link services

Letting Monthly Statements Do The Work For YOU

NCOA-LINK

16

Internet Skip Trace Many different websites to assist you

www411com

wwwuspscom

wwwgooglecom

Other people search sites

The cost vary from $100 to $35000

Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People

Name Age Previous

Cities DOB Phone Address Avg Income

Avg Home

Value Relatives

1

Yvonne D

Dailey

38 Bradenton FL

Oneco FL

Randall T

Dailey (40)

Connie Y

Dailey (70)

Thomas M

Dailey (70)

Constance Y

Dailey (70)

William F

Dailey (36)

2

Yvonne D

Dailey

41

Long Branch

NJ

Albuquerque

NM

Toms River

NJ

Delroy A

Dailey (40)

Bill Dailey

Mr Dailey

3 Yvonne D

Dailey

52

Austin TX

Claremore

OK

Spicewood

TX

Camille

Yvonne

Dailey (52)

Jon Dailey

Perform written as well as oral communications Use the collection letters

Call the patient if over 60 days

Offer a payment plan and stick to it

Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place

9

Medical Billing Process Denial Management

Know the difference between a denial and rejection

Letrsquos review denial code CO50

PR27

Which is a rejection and which is a denial

Understand how to read your EOBs

Just because the EOB states to write it off doesnrsquot always mean you write it off

APPEAL APPEAL APPEAL

Medical Billing Process Denial Management

Clearinghouse Dashboards

Gives complete summary (accepted denials)

Overview of your top rejections

Use as training tool

Share your findings with staff and providers

Inform provider not everything gets paid

Medical Billing Process Denial Management

10

Medical Billing Process Denial Management

Medical Billing Process Cost For NOT Working Denials

90 CLAIMS PER DAY AT $90 PER CLAIM = $8100

IF 10 DENIED = $810 IN DENIAL PER DAY

IF ONLY 1 IN 10 DENIALS ARE APPEALED IT =$72900 PER DAY

52 WEEKS X 5 DAYS ndash 20 DAY (VACATIONS AND HOLIDAYS) = 240 WORKING DAYS

240 DAYS X $72900 = $174960 LOST PER YEAR

Medical Billing Process Useful Reports

Practice Analysis

Insurance Aging (90 120 151)

Secondary Aging (medigap claims)

Procedure Analysis

Diagnosis Analysis

Patient Aging

Denial Report

Surgery Report

11

Timely Filing Guidelines Carrier Time Frame

United Health Care 90 Days from date of Service

Oxford 90 Days from Date of Service

Aetna 180 Days from Date of Service

Cigna 90 Days from Date of Service

Cigna Great West 15 months

Medicare 12 months (Calendar )

This will differ if the provider is NON PAR For example Cigna is 180 Days

Proof of Timely Filing Most carriers want your EDI reports to show claims

accepted and acknowledged by Payor

Some Carriers REQUIRE you use their forms to appeal

Itrsquos not enough to have an acceptance from your clearinghouse They want acknowledgement that THEY received it

If you mailed your claims then you should have mailed certified with return receipt

Corrective Claims Guidelines Carrier Time Frame

United Health Care 60 Days from date of remit

Oxford 60 Days from date of remit

Aetna 12 Months from date of remit

Cigna 180 Days from date of remit

Some may require that you use THEIR forms others may allow you to simply write a request Forms may vary depending on state where provider is located Should ALWAYS BE SENT CERTIFIED WITH RETURN RECEIPT Keep a file andor log so you can track

12

Reasons Patients DONrsquoT Pay Job loss reduced income

Emergency situations

Loss of insurance coverage

Hardship

Not understanding insurance plans

Wasnrsquot aware they owed

Killing The Awkward Silence Of Collecting Money

Kill it with kindness

Keep it simple keep it professional be assertive

Offer multiple payment options

Different Type of Collections Letters Financial Policy

Funds Were Paid To Patient

Past Due Notices (30 60 90)

Offering Different Payment Methods

No Payment Received By Carriers

Pre-Existing Clause

Insurance Verification Letter

Financial Hardship

13

The Cost To Collect A Copay Copay

Amount CashCheck

at time of service

Credit Card payment in

office

Billing the patient

Billing the patient TWICE

$2000 $0 ($2000) $96 ($1904) $300 (1700) $600 (1400)

Patient has been billed three times and NEVER Pays

- $2900

Different Payment Options Debit Cards

Credit Cards

Online AUTOMATIC withdrawals from checking or savings

Check

Cash

Via your website

Paypal

Online Bill Payment Merchant accounts now offer ways to pay by credit

card via the internet where the patient feels comfortable putting in their own information For example we use Netdeposit Set up direct payment out of their check savings and or credit card Taken out automatically monthly or bimonthly

( check payment online)

14

The Benefits Of Online Bill Payments Automatic debit from any account type

Recurring payment schedules

View payment history

View future payments

Archived payment receipts

Receipts emailed to both patient and practice

Payment scheduled is also emailed to patient and practice

Online Payment History

GENERAL TRANSACTION VIEW BEGINNING 02042013

Month Checks Ck Amt Credit Cards Credit Amt Total Rev

Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677

Skip Tracing Methods What is Skip Trace

Skip Trace Identifiers

Patientrsquos EXACT full name

Date of Birth or Age

Social Security Numbers

Previous Address ndash Last Known

Driverrsquos License Number

Insurance Policy Numbers

15

Skip Tracing Methods- Let Your Monthly

Statements Do the work For YOU

Use your Postal Service - Ancillary Service Endorsements

Return Service Requested

Temp-Return Service Requested

Address Service Requested

Change Service Requested

NCOA-Link services

Letting Monthly Statements Do The Work For YOU

NCOA-LINK

16

Internet Skip Trace Many different websites to assist you

www411com

wwwuspscom

wwwgooglecom

Other people search sites

The cost vary from $100 to $35000

Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People

Name Age Previous

Cities DOB Phone Address Avg Income

Avg Home

Value Relatives

1

Yvonne D

Dailey

38 Bradenton FL

Oneco FL

Randall T

Dailey (40)

Connie Y

Dailey (70)

Thomas M

Dailey (70)

Constance Y

Dailey (70)

William F

Dailey (36)

2

Yvonne D

Dailey

41

Long Branch

NJ

Albuquerque

NM

Toms River

NJ

Delroy A

Dailey (40)

Bill Dailey

Mr Dailey

3 Yvonne D

Dailey

52

Austin TX

Claremore

OK

Spicewood

TX

Camille

Yvonne

Dailey (52)

Jon Dailey

Perform written as well as oral communications Use the collection letters

Call the patient if over 60 days

Offer a payment plan and stick to it

Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place

10

Medical Billing Process Denial Management

Medical Billing Process Cost For NOT Working Denials

90 CLAIMS PER DAY AT $90 PER CLAIM = $8100

IF 10 DENIED = $810 IN DENIAL PER DAY

IF ONLY 1 IN 10 DENIALS ARE APPEALED IT =$72900 PER DAY

52 WEEKS X 5 DAYS ndash 20 DAY (VACATIONS AND HOLIDAYS) = 240 WORKING DAYS

240 DAYS X $72900 = $174960 LOST PER YEAR

Medical Billing Process Useful Reports

Practice Analysis

Insurance Aging (90 120 151)

Secondary Aging (medigap claims)

Procedure Analysis

Diagnosis Analysis

Patient Aging

Denial Report

Surgery Report

11

Timely Filing Guidelines Carrier Time Frame

United Health Care 90 Days from date of Service

Oxford 90 Days from Date of Service

Aetna 180 Days from Date of Service

Cigna 90 Days from Date of Service

Cigna Great West 15 months

Medicare 12 months (Calendar )

This will differ if the provider is NON PAR For example Cigna is 180 Days

Proof of Timely Filing Most carriers want your EDI reports to show claims

accepted and acknowledged by Payor

Some Carriers REQUIRE you use their forms to appeal

Itrsquos not enough to have an acceptance from your clearinghouse They want acknowledgement that THEY received it

If you mailed your claims then you should have mailed certified with return receipt

Corrective Claims Guidelines Carrier Time Frame

United Health Care 60 Days from date of remit

Oxford 60 Days from date of remit

Aetna 12 Months from date of remit

Cigna 180 Days from date of remit

Some may require that you use THEIR forms others may allow you to simply write a request Forms may vary depending on state where provider is located Should ALWAYS BE SENT CERTIFIED WITH RETURN RECEIPT Keep a file andor log so you can track

12

Reasons Patients DONrsquoT Pay Job loss reduced income

Emergency situations

Loss of insurance coverage

Hardship

Not understanding insurance plans

Wasnrsquot aware they owed

Killing The Awkward Silence Of Collecting Money

Kill it with kindness

Keep it simple keep it professional be assertive

Offer multiple payment options

Different Type of Collections Letters Financial Policy

Funds Were Paid To Patient

Past Due Notices (30 60 90)

Offering Different Payment Methods

No Payment Received By Carriers

Pre-Existing Clause

Insurance Verification Letter

Financial Hardship

13

The Cost To Collect A Copay Copay

Amount CashCheck

at time of service

Credit Card payment in

office

Billing the patient

Billing the patient TWICE

$2000 $0 ($2000) $96 ($1904) $300 (1700) $600 (1400)

Patient has been billed three times and NEVER Pays

- $2900

Different Payment Options Debit Cards

Credit Cards

Online AUTOMATIC withdrawals from checking or savings

Check

Cash

Via your website

Paypal

Online Bill Payment Merchant accounts now offer ways to pay by credit

card via the internet where the patient feels comfortable putting in their own information For example we use Netdeposit Set up direct payment out of their check savings and or credit card Taken out automatically monthly or bimonthly

( check payment online)

14

The Benefits Of Online Bill Payments Automatic debit from any account type

Recurring payment schedules

View payment history

View future payments

Archived payment receipts

Receipts emailed to both patient and practice

Payment scheduled is also emailed to patient and practice

Online Payment History

GENERAL TRANSACTION VIEW BEGINNING 02042013

Month Checks Ck Amt Credit Cards Credit Amt Total Rev

Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677

Skip Tracing Methods What is Skip Trace

Skip Trace Identifiers

Patientrsquos EXACT full name

Date of Birth or Age

Social Security Numbers

Previous Address ndash Last Known

Driverrsquos License Number

Insurance Policy Numbers

15

Skip Tracing Methods- Let Your Monthly

Statements Do the work For YOU

Use your Postal Service - Ancillary Service Endorsements

Return Service Requested

Temp-Return Service Requested

Address Service Requested

Change Service Requested

NCOA-Link services

Letting Monthly Statements Do The Work For YOU

NCOA-LINK

16

Internet Skip Trace Many different websites to assist you

www411com

wwwuspscom

wwwgooglecom

Other people search sites

The cost vary from $100 to $35000

Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People

Name Age Previous

Cities DOB Phone Address Avg Income

Avg Home

Value Relatives

1

Yvonne D

Dailey

38 Bradenton FL

Oneco FL

Randall T

Dailey (40)

Connie Y

Dailey (70)

Thomas M

Dailey (70)

Constance Y

Dailey (70)

William F

Dailey (36)

2

Yvonne D

Dailey

41

Long Branch

NJ

Albuquerque

NM

Toms River

NJ

Delroy A

Dailey (40)

Bill Dailey

Mr Dailey

3 Yvonne D

Dailey

52

Austin TX

Claremore

OK

Spicewood

TX

Camille

Yvonne

Dailey (52)

Jon Dailey

Perform written as well as oral communications Use the collection letters

Call the patient if over 60 days

Offer a payment plan and stick to it

Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place

11

Timely Filing Guidelines Carrier Time Frame

United Health Care 90 Days from date of Service

Oxford 90 Days from Date of Service

Aetna 180 Days from Date of Service

Cigna 90 Days from Date of Service

Cigna Great West 15 months

Medicare 12 months (Calendar )

This will differ if the provider is NON PAR For example Cigna is 180 Days

Proof of Timely Filing Most carriers want your EDI reports to show claims

accepted and acknowledged by Payor

Some Carriers REQUIRE you use their forms to appeal

Itrsquos not enough to have an acceptance from your clearinghouse They want acknowledgement that THEY received it

If you mailed your claims then you should have mailed certified with return receipt

Corrective Claims Guidelines Carrier Time Frame

United Health Care 60 Days from date of remit

Oxford 60 Days from date of remit

Aetna 12 Months from date of remit

Cigna 180 Days from date of remit

Some may require that you use THEIR forms others may allow you to simply write a request Forms may vary depending on state where provider is located Should ALWAYS BE SENT CERTIFIED WITH RETURN RECEIPT Keep a file andor log so you can track

12

Reasons Patients DONrsquoT Pay Job loss reduced income

Emergency situations

Loss of insurance coverage

Hardship

Not understanding insurance plans

Wasnrsquot aware they owed

Killing The Awkward Silence Of Collecting Money

Kill it with kindness

Keep it simple keep it professional be assertive

Offer multiple payment options

Different Type of Collections Letters Financial Policy

Funds Were Paid To Patient

Past Due Notices (30 60 90)

Offering Different Payment Methods

No Payment Received By Carriers

Pre-Existing Clause

Insurance Verification Letter

Financial Hardship

13

The Cost To Collect A Copay Copay

Amount CashCheck

at time of service

Credit Card payment in

office

Billing the patient

Billing the patient TWICE

$2000 $0 ($2000) $96 ($1904) $300 (1700) $600 (1400)

Patient has been billed three times and NEVER Pays

- $2900

Different Payment Options Debit Cards

Credit Cards

Online AUTOMATIC withdrawals from checking or savings

Check

Cash

Via your website

Paypal

Online Bill Payment Merchant accounts now offer ways to pay by credit

card via the internet where the patient feels comfortable putting in their own information For example we use Netdeposit Set up direct payment out of their check savings and or credit card Taken out automatically monthly or bimonthly

( check payment online)

14

The Benefits Of Online Bill Payments Automatic debit from any account type

Recurring payment schedules

View payment history

View future payments

Archived payment receipts

Receipts emailed to both patient and practice

Payment scheduled is also emailed to patient and practice

Online Payment History

GENERAL TRANSACTION VIEW BEGINNING 02042013

Month Checks Ck Amt Credit Cards Credit Amt Total Rev

Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677

Skip Tracing Methods What is Skip Trace

Skip Trace Identifiers

Patientrsquos EXACT full name

Date of Birth or Age

Social Security Numbers

Previous Address ndash Last Known

Driverrsquos License Number

Insurance Policy Numbers

15

Skip Tracing Methods- Let Your Monthly

Statements Do the work For YOU

Use your Postal Service - Ancillary Service Endorsements

Return Service Requested

Temp-Return Service Requested

Address Service Requested

Change Service Requested

NCOA-Link services

Letting Monthly Statements Do The Work For YOU

NCOA-LINK

16

Internet Skip Trace Many different websites to assist you

www411com

wwwuspscom

wwwgooglecom

Other people search sites

The cost vary from $100 to $35000

Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People

Name Age Previous

Cities DOB Phone Address Avg Income

Avg Home

Value Relatives

1

Yvonne D

Dailey

38 Bradenton FL

Oneco FL

Randall T

Dailey (40)

Connie Y

Dailey (70)

Thomas M

Dailey (70)

Constance Y

Dailey (70)

William F

Dailey (36)

2

Yvonne D

Dailey

41

Long Branch

NJ

Albuquerque

NM

Toms River

NJ

Delroy A

Dailey (40)

Bill Dailey

Mr Dailey

3 Yvonne D

Dailey

52

Austin TX

Claremore

OK

Spicewood

TX

Camille

Yvonne

Dailey (52)

Jon Dailey

Perform written as well as oral communications Use the collection letters

Call the patient if over 60 days

Offer a payment plan and stick to it

Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place

12

Reasons Patients DONrsquoT Pay Job loss reduced income

Emergency situations

Loss of insurance coverage

Hardship

Not understanding insurance plans

Wasnrsquot aware they owed

Killing The Awkward Silence Of Collecting Money

Kill it with kindness

Keep it simple keep it professional be assertive

Offer multiple payment options

Different Type of Collections Letters Financial Policy

Funds Were Paid To Patient

Past Due Notices (30 60 90)

Offering Different Payment Methods

No Payment Received By Carriers

Pre-Existing Clause

Insurance Verification Letter

Financial Hardship

13

The Cost To Collect A Copay Copay

Amount CashCheck

at time of service

Credit Card payment in

office

Billing the patient

Billing the patient TWICE

$2000 $0 ($2000) $96 ($1904) $300 (1700) $600 (1400)

Patient has been billed three times and NEVER Pays

- $2900

Different Payment Options Debit Cards

Credit Cards

Online AUTOMATIC withdrawals from checking or savings

Check

Cash

Via your website

Paypal

Online Bill Payment Merchant accounts now offer ways to pay by credit

card via the internet where the patient feels comfortable putting in their own information For example we use Netdeposit Set up direct payment out of their check savings and or credit card Taken out automatically monthly or bimonthly

( check payment online)

14

The Benefits Of Online Bill Payments Automatic debit from any account type

Recurring payment schedules

View payment history

View future payments

Archived payment receipts

Receipts emailed to both patient and practice

Payment scheduled is also emailed to patient and practice

Online Payment History

GENERAL TRANSACTION VIEW BEGINNING 02042013

Month Checks Ck Amt Credit Cards Credit Amt Total Rev

Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677

Skip Tracing Methods What is Skip Trace

Skip Trace Identifiers

Patientrsquos EXACT full name

Date of Birth or Age

Social Security Numbers

Previous Address ndash Last Known

Driverrsquos License Number

Insurance Policy Numbers

15

Skip Tracing Methods- Let Your Monthly

Statements Do the work For YOU

Use your Postal Service - Ancillary Service Endorsements

Return Service Requested

Temp-Return Service Requested

Address Service Requested

Change Service Requested

NCOA-Link services

Letting Monthly Statements Do The Work For YOU

NCOA-LINK

16

Internet Skip Trace Many different websites to assist you

www411com

wwwuspscom

wwwgooglecom

Other people search sites

The cost vary from $100 to $35000

Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People

Name Age Previous

Cities DOB Phone Address Avg Income

Avg Home

Value Relatives

1

Yvonne D

Dailey

38 Bradenton FL

Oneco FL

Randall T

Dailey (40)

Connie Y

Dailey (70)

Thomas M

Dailey (70)

Constance Y

Dailey (70)

William F

Dailey (36)

2

Yvonne D

Dailey

41

Long Branch

NJ

Albuquerque

NM

Toms River

NJ

Delroy A

Dailey (40)

Bill Dailey

Mr Dailey

3 Yvonne D

Dailey

52

Austin TX

Claremore

OK

Spicewood

TX

Camille

Yvonne

Dailey (52)

Jon Dailey

Perform written as well as oral communications Use the collection letters

Call the patient if over 60 days

Offer a payment plan and stick to it

Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place

13

The Cost To Collect A Copay Copay

Amount CashCheck

at time of service

Credit Card payment in

office

Billing the patient

Billing the patient TWICE

$2000 $0 ($2000) $96 ($1904) $300 (1700) $600 (1400)

Patient has been billed three times and NEVER Pays

- $2900

Different Payment Options Debit Cards

Credit Cards

Online AUTOMATIC withdrawals from checking or savings

Check

Cash

Via your website

Paypal

Online Bill Payment Merchant accounts now offer ways to pay by credit

card via the internet where the patient feels comfortable putting in their own information For example we use Netdeposit Set up direct payment out of their check savings and or credit card Taken out automatically monthly or bimonthly

( check payment online)

14

The Benefits Of Online Bill Payments Automatic debit from any account type

Recurring payment schedules

View payment history

View future payments

Archived payment receipts

Receipts emailed to both patient and practice

Payment scheduled is also emailed to patient and practice

Online Payment History

GENERAL TRANSACTION VIEW BEGINNING 02042013

Month Checks Ck Amt Credit Cards Credit Amt Total Rev

Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677

Skip Tracing Methods What is Skip Trace

Skip Trace Identifiers

Patientrsquos EXACT full name

Date of Birth or Age

Social Security Numbers

Previous Address ndash Last Known

Driverrsquos License Number

Insurance Policy Numbers

15

Skip Tracing Methods- Let Your Monthly

Statements Do the work For YOU

Use your Postal Service - Ancillary Service Endorsements

Return Service Requested

Temp-Return Service Requested

Address Service Requested

Change Service Requested

NCOA-Link services

Letting Monthly Statements Do The Work For YOU

NCOA-LINK

16

Internet Skip Trace Many different websites to assist you

www411com

wwwuspscom

wwwgooglecom

Other people search sites

The cost vary from $100 to $35000

Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People

Name Age Previous

Cities DOB Phone Address Avg Income

Avg Home

Value Relatives

1

Yvonne D

Dailey

38 Bradenton FL

Oneco FL

Randall T

Dailey (40)

Connie Y

Dailey (70)

Thomas M

Dailey (70)

Constance Y

Dailey (70)

William F

Dailey (36)

2

Yvonne D

Dailey

41

Long Branch

NJ

Albuquerque

NM

Toms River

NJ

Delroy A

Dailey (40)

Bill Dailey

Mr Dailey

3 Yvonne D

Dailey

52

Austin TX

Claremore

OK

Spicewood

TX

Camille

Yvonne

Dailey (52)

Jon Dailey

Perform written as well as oral communications Use the collection letters

Call the patient if over 60 days

Offer a payment plan and stick to it

Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place

14

The Benefits Of Online Bill Payments Automatic debit from any account type

Recurring payment schedules

View payment history

View future payments

Archived payment receipts

Receipts emailed to both patient and practice

Payment scheduled is also emailed to patient and practice

Online Payment History

GENERAL TRANSACTION VIEW BEGINNING 02042013

Month Checks Ck Amt Credit Cards Credit Amt Total Rev

Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677

Skip Tracing Methods What is Skip Trace

Skip Trace Identifiers

Patientrsquos EXACT full name

Date of Birth or Age

Social Security Numbers

Previous Address ndash Last Known

Driverrsquos License Number

Insurance Policy Numbers

15

Skip Tracing Methods- Let Your Monthly

Statements Do the work For YOU

Use your Postal Service - Ancillary Service Endorsements

Return Service Requested

Temp-Return Service Requested

Address Service Requested

Change Service Requested

NCOA-Link services

Letting Monthly Statements Do The Work For YOU

NCOA-LINK

16

Internet Skip Trace Many different websites to assist you

www411com

wwwuspscom

wwwgooglecom

Other people search sites

The cost vary from $100 to $35000

Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People

Name Age Previous

Cities DOB Phone Address Avg Income

Avg Home

Value Relatives

1

Yvonne D

Dailey

38 Bradenton FL

Oneco FL

Randall T

Dailey (40)

Connie Y

Dailey (70)

Thomas M

Dailey (70)

Constance Y

Dailey (70)

William F

Dailey (36)

2

Yvonne D

Dailey

41

Long Branch

NJ

Albuquerque

NM

Toms River

NJ

Delroy A

Dailey (40)

Bill Dailey

Mr Dailey

3 Yvonne D

Dailey

52

Austin TX

Claremore

OK

Spicewood

TX

Camille

Yvonne

Dailey (52)

Jon Dailey

Perform written as well as oral communications Use the collection letters

Call the patient if over 60 days

Offer a payment plan and stick to it

Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place

15

Skip Tracing Methods- Let Your Monthly

Statements Do the work For YOU

Use your Postal Service - Ancillary Service Endorsements

Return Service Requested

Temp-Return Service Requested

Address Service Requested

Change Service Requested

NCOA-Link services

Letting Monthly Statements Do The Work For YOU

NCOA-LINK

16

Internet Skip Trace Many different websites to assist you

www411com

wwwuspscom

wwwgooglecom

Other people search sites

The cost vary from $100 to $35000

Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People

Name Age Previous

Cities DOB Phone Address Avg Income

Avg Home

Value Relatives

1

Yvonne D

Dailey

38 Bradenton FL

Oneco FL

Randall T

Dailey (40)

Connie Y

Dailey (70)

Thomas M

Dailey (70)

Constance Y

Dailey (70)

William F

Dailey (36)

2

Yvonne D

Dailey

41

Long Branch

NJ

Albuquerque

NM

Toms River

NJ

Delroy A

Dailey (40)

Bill Dailey

Mr Dailey

3 Yvonne D

Dailey

52

Austin TX

Claremore

OK

Spicewood

TX

Camille

Yvonne

Dailey (52)

Jon Dailey

Perform written as well as oral communications Use the collection letters

Call the patient if over 60 days

Offer a payment plan and stick to it

Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place

16

Internet Skip Trace Many different websites to assist you

www411com

wwwuspscom

wwwgooglecom

Other people search sites

The cost vary from $100 to $35000

Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People

Name Age Previous

Cities DOB Phone Address Avg Income

Avg Home

Value Relatives

1

Yvonne D

Dailey

38 Bradenton FL

Oneco FL

Randall T

Dailey (40)

Connie Y

Dailey (70)

Thomas M

Dailey (70)

Constance Y

Dailey (70)

William F

Dailey (36)

2

Yvonne D

Dailey

41

Long Branch

NJ

Albuquerque

NM

Toms River

NJ

Delroy A

Dailey (40)

Bill Dailey

Mr Dailey

3 Yvonne D

Dailey

52

Austin TX

Claremore

OK

Spicewood

TX

Camille

Yvonne

Dailey (52)

Jon Dailey

Perform written as well as oral communications Use the collection letters

Call the patient if over 60 days

Offer a payment plan and stick to it

Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place

17

Small Claims vs Collection Agency Know when to cut your losses and at what price

Regardless of route you use you will need to prove your collection efforts

Small claims will cost you the cost of court plus the attorney fee ndash Patients fear court

Collection Agency ndash negotiate your fees (28 to 45 of collections)

Questions Thank you for attending

How to contact us infodaileybillingcom

Yvonne Dailey CPCCPCI ydaileydaileybillingcom

Website wwwdaileybillingcom

Resources United States Postal Service wwwuspscom

Netdeposit ndash wwwnetdepositcom Online Merchant Vendor

Useful websites www411com wwwyellowbookcom

Example letters Yvonne Dailey-Dailey Billing Services wwwdaileybillingcom