HCPro.com: Managed Care Contracting and Reimbursement Advisor

Managed Care Contracting & Reimbursement Advisor tells you exactly what you must know and do to successfully negotiate the best deal with HMOs, PPOs, and other payors - and get bigger and faster reimbursement!

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April 2008 (Volume 5, Issue 4)	view entire issue

Conduct E/M coding audit to ensure compliance, enhance practice revenue
Editor's note: In the first article of a two-part series, MCCRA talks to coding experts about the use of internal coding audits to assess their readiness for an external audit and prevent the leakage of revenue. Part two will discuss training physicians and staff members to improve coding. A coding audit is a terrific tool for physician practices to spot deficiencies in their claims submissions, especially for E/M codes. Identifying shortcomings in coding is important for two reasons. First, the OIG expects healthcare providers to ensure that claims they submit to federal healthcare programs, such as Medicare and Medicaid, are accurate. Second, systematic undercoding by one or more providers leads to revenue shortfalls for physician practices.

Target front-desk staff to improve collection of patient deductibles, especially for high-deductible health plans
Although health insurance policies with deductibles aren't new, the policies are multiplying and the deductibles are growing. Consequently, providers need to minimize the risk that they'll be unable to collect a patient's deductible, either at or following the time of service. The front desk is the most important position in the collections process, says Reed Tinsley, CPA, CVA, CFP, principal at Reed Tinsley & Associates in Houston. That many practices pay their front office staff the lowest salaries and provide little or no training is "a recipe for disaster" in the face of rising patient financial responsibilities, Tinsley says.

E-tool: Basic checklist for E/M documentation


E-tool: Sample contract language addresses collection efforts
Editor's note: You can use the following sample contract language to improve your ability to collect any balance due from an insurance plan when the member hasn't met his or her deductible.

Other recently-published articles from Managed Care Contracting and Reimbursement Advisor:

Use lean cost accounting to examine your cost structure

Bridges to Excellence pays bonuses to docs for implementing medical home

Ensure that contracts cover real-time claims adjudication

Build a defensible fee schedule to challenge lowball payer contracts

Use retail clinic referrals to boost your bottom line

E-visit payment promising but not ready for prime time

Think twice before opting out of Medicare

Prepare for contracting challenges during mergers, consolidations

E-tool: Sample letter to payer on intention to renegotiate

E-tool: Payer/MCO contract provision samples

Watch your contracts in the wake of ’final’ Stark rules

Put these provisions on your managed care contracting hot list

Audit your patient financial services department to maximize your managed care reimbursement

Push the envelope when contracting with highly scrutinized payers

Case study: Go electronic on your charge capture process

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