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Billing: Don't wait for updates

Billing: Don't wait for updates

Q. Payer requirements change frequently, and I feel like we're the last to know. What is the best way to ensure my procedures are in line with the most recent guidelines?

A. Keeping up with changing policies across a broad payer mix can be a daunting task. It's like trying to play a game when your opponent is making the rules up as they go.  Fortunately, there are measures that you can take to ensure your cash flow doesn't suffer. Don't wait on denials or audits to figure out that you don't have it figured out. Providers should implement the tasks below to get ahead of the game. If your team isn't large enough to delegate these tasks to, it may be time to outsource. A knowledgeable billing service can be your saving grace when it comes to keeping up with all the changes.

Review Contracts
Locate your managed care contracts and become familiar with the contents. Use the information in each contract to develop a policy that your team will follow for each payer.

Assign Payer Groups
Divide your payers into groups of similarity. Then have a team member responsible for updating and maintaining your policy on that payer group.

Sign up for Listservs and Emails
Make sure you sign up to receive information sent out by payers. This information can be used to update your policy and prevent denials due to recent changes.

Get Access
Your team should have access to the provider portals for your payers. The information on these websites is your most useful tool in staying up to date.

Schedule Meetings
Have regular meetings with your local provider reps from your largest payers to discuss discrepancies between policy and payments. In addition, schedule regular meetings with team members so knowledge can be shared.

Dawn Chapman is owner of Chapman DME Billing. Reach her at


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