Billing: Get back to basics

Q. The industry focus has changed due to lower reimbursements, stringent documentation requirements, and working with a leaner staff making intake key. Can we go back to the basics of reviewing the intake process?
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Tuesday, May 29, 2018

A. Your intake team is responsible for collecting the order, medical records and supporting documentation. If any required information is missing or inaccurate, the team must go back to the referral source to obtain the correct information and explain why it is needed. This is why it is so important to ensure your intake staff is thoroughly educated about medical policy requirements and company policies.

The intake process needs to be so clean that when the documentation gets to the billing team, the claim is ready to be submitted for payment.

Collecting information from both the patient and the referral source is critically important, making sure coverage criteria is met and verifying the patient’s information for claim submission. It starts with the correct spelling of the patient’s name and the patient’s current and permanent addresses. The permanent address on file with Social Security is important to know because it could be in a competitive bid area or have a representative payee on file, which affects how the claim is processed and reimbursed. 

The patient’s file must contain a copy of their insurance card. Do not rely on another health care entity (e.g., hospital) for accurate insurance information for DME benefits. 

Emergency contact information is important. This should be someone who does not live with the patient, such as a family member, neighbor or friend. This is helpful in situations where the patient does not return phone calls, needs to return equipment, or has an outstanding balance.

Implementing flow sheets for the intake to billing process is beneficial for making sure all the necessary steps are followed and completed.

Ronda Buhrmester is director of reimbursement for The VGM Group. Reach her at ronda.buhrmester@vgm.com.