Sunday, October 31, 2004

Cleaning up the claims
With Sarah Hanna

Q. With the looming cuts in Medicare reimbursement in 2005, how do I track my billing staff for efficiency and clean claim processing?

A. With the upcoming Medicare cuts, it is even more important for a manager and/or owner to track the efficiencies of their billing department. However, many managers and owners are not familiar with the reimbursement process and rely heavily on the word of their billing personnel regarding the day to day operations. Having an overall knowledge of the process will assist you in determining fact from fiction.

The first place to start when tracking your billing personnel is with a detailed job description or duty list. You can then take this list and transfer it onto a tracking spreadsheet that you receive weekly or bi-monthly. For example, if your AR person is in charge of claim re-submissions, reviews and tracking for claims status, etc.; then have him/her track the number of re-submits, reviews and phone calls that were done and the dollar amount that was re-submitted or reviewed. A comment section on the spreadsheet is advisable in order to further understand what was done after the call was made or review sent. The number of claims checked using Voice Response or Internet should also be listed. A mutually agreed upon goal for the number of reviews, re-subs and status checks is needed. There are other areas of their job duties that you may want to add depending on the needs of your organization.

This tracking spreadsheet is one of many tracking tools that can be developed in addition to your monthly aging reports, DSO, and CMN holding revenue and rate of return. By staying on top of your people through detailed reporting guidelines, you will be more in control of your reimbursable dollars.

Contact Sarah Hanna , vice president of ECS Billing & Consulting, Inc. at 419-448-5332 or