It is critical for a healthcare organization to have individuals who are experts on managing major insurances. Your billing staff needs this knowledge for accurate payment posting, AR follow up and denial management. This is vital for your business, as it helps to maximize your monthly revenue performance.

We are sure your staff is continuously researching for new information or new functionalities. But remember: It is not just a matter of billing the payer and tracking claims, it’s a matter of understanding payers, patient performance and accountability.

In the day to day practice, our team of Revenue Cycle specialists have identified errors that were overlooked by the billing staff and resulted in a high volume of denials for our partners in the past. In this issue, we highlight four of them that will help boost your reimbursement:

1. Correct use of modifier –PT

The use of the modifier –PT applies when a colorectal cancer screening test that is converted to diagnostic test or other procedure. It indicates that this procedure began as a screening colonoscopy or screening sigmoidoscopy. Keep in mind that you should add it too when the screening test becomes a diagnostic service based on the results of a barium enema.

Failing to including modifier -PT to a diagnostic procedure code that requires it, could cost you thousands of dollars if it is a recurring process.

2. Waiving Patient’s Responsibility

There are different scenarios in which healthcare providers may feel it is appropriate to waive the patient’s insurance responsibility. We understand if you would like to extend professional courtesy to colleagues or their families, patients in financial distress or if collection efforts have negligible results.

The fastest way to increase cash flow and improve collection rates is to collect patient responsibility up front. Sometimes, patients are less inclined to pay or are difficult to reach due to communication or location as limiting factors, once the services have been performed.

Please remember that it is a felony to routinely waive the collection of copays, coinsurance, and deductibles for patients. This is a crime of health insurance fraud because your office is claiming the wrong charge for services when insurance claims are created.

3. If your clinic is open on Saturdays, you might be eligible for extra reimbursement.

When the services are provided before or after the posted hours of operation in accordance with the clinic’s policies, procedures, and employment contracts, you may separately get reimbursed for those services.

4. Billing Laboratory services.

We know that RHCs are required to “directly furnish routine diagnostic and laboratory services” and to “furnish onsite all of the following six laboratory tests”.

RHCs bill Part B separately for the technical components of diagnostic tests, labs, and venipunctures. They are not bundled with the all-inclusive rate (since January 1, 2001).

This is a recurring issue found in struggling Rural Hospitals all across the country and it is a situation we have corrected in most of our current partners who were missing on extra reimbursement for billing laboratory services incorrectly. Make sure your team look for processed claims that include these type of services and reprocess accordingly if possible.

Editor’s note: Alicia Gutierrez, Training and Development Officer at Smrtdo Medical Billing, answered this question.

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