Monday, January 31, 2005

Finding the last 20%
with Esther Apter
E. Apter

Q. How can I find the revenue to stay profitable despite the upcoming oxygen cuts?

A. When reimbursement cuts hit, there are only two ways to stay afloat - find additional revenue or cut expenses. Cutting expenses is often difficult without sacrificing service or quality. The only other option is to search for additional revenue. How about co-insurance? Co-insurance billing is the process required to collect the 20% portion Medicare does not pay.

There are three different ways to collect co-insurance: Rely on Medicare crossover, bill for claims that did not crossover or b ill the patient for co-insurance.

Thirty to 50% of claims that Medicare crosses over to secondary insurance companies are not paid through crossover and require a resubmission of the claim. Many claims are paid to the patient. Therefore, don’t assume claims marked as forwarded by Medicare will automatically pay. Create a tickler system to audit crossed over claims 30-45 days after Medicare paid the claim. Look for software to help you manage this audit. This audit will capture claims that got “lost” in the crossover process. Relying on crossover could cause loss of revenue for claims that either did not get processed through crossover or were paid to the patient. Most co-insurance claims must be submitted hard copy with a copy of the primary EOMB. Evaluate your procedures to submit these claims. Look for ways to cut costs by simplifying the process of finding and copying the EOMBs required for submission and payment.

Esther Apter is the CEO of MedFORCE Technologies. She can be reached at 1-866-237-1190 or at