H O W T O B R I N G B I L L I N G B A C K I N H O U S E

Transcription

1 H O W T O B R I N G B I L L I N G B A C K I N H O U S E R C M B R A I N. C O M

2 I N T R O D U C T I O N You had good reasons for outsourcing your billing. But it s been headache after headache for your medical business. Now, you re having a hard time remembering what those reasons were. Are you considering moving your billing back in house? Not sure where to start? This guide can help the process feel less overwhelming and show you how to make the move as streamlined as possible. Y O U R B I L L I N G B E L O N G S I N H O U S E As your medical business grew, so did your AR department s workload. Rather than bog down your talented team with a mountain of paperwork, you understandably decided to hand off the most tedious aspect of your practice s work to a company that specializes in billing. And, for a while, things went pretty smoothly. Or so it seemed. N E E D H E L P? To learn the benefits of moving your billing back in house and how the RCM Brain ninjas can help you make this transition efficiently, read on below. For your personal consultation to hear more, call us at RCM-BETH or visit rcmbrain.com. Before long, you started to realize that outsourcing your billing hadn t actually resolved any of the issues you were hoping to address. Instead, your old problems persisted and a new one the billing company itself became more and more apparent. And you were still on the hook to pay their fee each month.

3 C O M M O N I S S U E S W I T H B I L L I N G C O M P A N I E S

4 R E V E N U E L E A K A G E Initially, you thought this investment would be worth it. But let s look at the numbers for a moment. On average, a provider pays a billing company 6% of the money the billing company collects for the provider. That figure would be well worth it for most providers that don t want to deal with the hassles of in-house billing. But when you also factor in that the average billing companies has 10% revenue leakage, you start to realize that you re not just paying the billing company for the revenue the collect. You re paying them even when they re doing an inadequate job and losing you revenue too. -$7,700 per month For a more specific example to put those percentages in perspective, let s say that your medical business could have potentially brought in $50K one month. But instead of bringing in that full amount, the billing company only collected $45K. After paying the billing company their 6%, the amount you actually receive drops even lower to $42,300. -$92,400 per year Another way to put that is that if your AR department had handled the billing and managed to avoid any revenue leakage, your medical business could have accrued an additional $7,700. That s an additional $92,400 and could be the difference between your business remaining independent or having to consider joining a hospital system, or worse, going out of business. Money (and money that you missed out on) is, of course, a very important factor for you to consider here. But it is far from the only concern in this scenario.

5 H I G H A R Another concern you may have with your current billing company is seeing a high amount of AR bring carried from month to month and, ultimately, being lost. This often occurs when a billing company is being paid a percentage of the value of each claim, so they cherry-pick the highest paying, easiest to close claims and quickly write off the rest. Your own staff may have had to make similar choices out of necessity before you outsourced your billing. You hoped the billing company, with its know-how and resources, would change things, but you only passed the coding and registration issues made in your office along down the line. And instead of working harder to get more of your claims paid, the billing company just gives you a never-ending stream of excuses. N O T R A N S P A R E N C Y Maybe one month you and your team members contacted the billing companies with some questions, inquiries you assumed would be quickly and transparently answered. But instead, you were met with a withholding black box. Frequently, billing companies report on the metrics that make them look good and little else. When asked follow-up questions about specific areas, they ll claim that the data isn t currently available. This lack of transparency typically breeds distrust and many medical businesses decide to switch from one billing company to another. While this tactic may work for some, it often results only in incremental growth. A much better financial decision would be bringing the workflow of filing and collecting claims back under the umbrella of your own business. As you ll see, bringing your billing back in house doesn t have to mean bringing the problems back too.

6 L O G I S T I C S Initially, you thought this investment would be worth it. But let s look at the numbers for a moment. On average, a provider pays a billing company 6% of the money the billing company collects for the provider. That figure would be well worth it for most providers that don t want to deal with the hassles of in-house billing. But when you also factor in that the average billing companies has 10% revenue leakage, you start to realize that you re not just paying the billing company for the revenue the collect. You re paying them even when they re doing an inadequate job and losing you revenue, too.

7 S O F T W A R E A major factor in moving your billing in house from an outsourced company is whose software is in place. In some instances, billing companies log in to your software and do their work using your practice management system and your clearinghouse. In this case the simplest transition scenario you would simply remove access from the billing company staff. Other billing companies extract the data needed to fill claims from your system, but then manage the flow of outbound claims and inbound payments through their own billing software. Companies typically do this to ensure standardization across their processes for the purpose of managing their staff, which is a worthwhile goal but can make it more difficult for your company to break ties. Another factor that will affect your transition away from a billing company, is how many tasks they do for your practice. For example, some billing companies perform coding services from chart notes, so they might have clinical documents they ve incorporated into their billing process. Others manage patient responsibility while many do not. Along with AR tasks, your medical business will need to move the other types of work your billing company formerly did back in house. We'll cover the data management component too, just in case this is your scenario.

8 C L E A R I N G H O U S E S E T U P For this transition, we ll need to ensure that your clearinghouse and practice management system are setup properly for all claims that can be submitted electronically and all payments that can be received electronically. We will also need to make sure you have a clearinghouse that gives you the capability to access your data, including the ability to: - Download your own 835s without having to go to multiple locations to get them - Check eligibility and benefits - Scrub claims before they go out the door We recommend verifying that you are using a modern clearinghouse with these features before you proceed. Oftentimes, a built-in clearinghouse function is tied to the practice management software that you re already using. However, you likely don t have full access to these clearinghouse-level features, and therefore aren't getting the benefits of seeing your data in the clearinghouse. But this may be an easy fix this because modern clearinghouses can augment the lack of revenue cycle features in practice management systems. P R A C T I C E M A N A G E M E N T S E T U P One of the most important decisions any provider will make is which practice management software they re going to use. Frequently, this decision was made several years ago and you may be living with the consequences. Bringing billing back in-house gives you the opportunity to make a fresh start in a new practice management system. If you re using a desktop-based software that is individually installed on machines, it would be a good idea to go ahead and make the switch to a cloud-based practice management software vendor. There are a lot of good vendors with a lot of predefined templates and functionality that allow you to get up and running very quickly. Most have the ability to import your data. The cost of investing in a new practice management setup will be returned in new found efficiency and the ability to customize the software for your unique needs, including accounting for specific billing rules.

9 D A T E S Managing the dates of transitioning your billing back in house will be critical to your success. These are the two most important dates you ll want to define: - The cutoff date after which no new claim will be processed by the billing company - When the billing company will stop following up on any payment files that come in from the payer These dates can be the same date, but some billing companies will spend an additional 30 days or more collecting on claims that were already submitted, ultimately getting paid on the ones that get collected within that period. It would be advantageous for you to cut ties as quickly as possible with a billing company and start working your AR in a different fashion, because billing companies have less incentive to aggressively follow up after submission of new claims has ended. Depending on the size of the company and other factors, their dedication to providing support as you transition away from their services will vary widely. In a smaller company, you may have a strong enough personal relationship to get that extra level of support. However, if it s a major priority that they replace you with a new client, the staff members you ve come to rely on will likely be redeployed to onboarding a new client. Typically, you should assume there will be a day period from the time of announcing cancellation of service to the time of actually performing all of the billing activities in-house.

10 D A T A M A N A G E M E N T The hardest part about transitioning your billing back in house may not be firing your current billing company or hiring new staff to manage your billing. It may actually be moving the ones and zeros around between systems to get organized and get back on the right track.

11 H I S T O R I C A L D A T A One major problem is handling all the historical data from past claims you need to account for. This becomes more complicated if your billing company has been billing claims out of their system from data they extracted from your system. In this case, you are likely missing a substantial amount of claims and payment data that you're going to need contained in your system. Through reporting tools and custom reports, billing companies have a way to export data from the software they are using. However, don't expect this exported data to be comprehensive, or the ability to import it directly into your new system. It will likely need to be transferred to a readable format first. These gaps in data can cause substantial challenges when you are trying to amass continuous information on claims that were billed and paid before and after the transition and you may even find yourself with exported files that were never reimported that are available for reference only in excel format. There are outside companies, such as RCM Brain, that can populate your local system with this extracted data so you won t have to wade through a mess of numbers.

12 C O N F I R M I N G C L A I M S T A T U S If you are trying to figure out which claims have been submitted, accepted, pended, denied, and paid, you're going to need to augment the data you have on file in your system with updated information from the payers. The fastest way to do this is to run a claim status check on any claim, on all of your patients. This will allow you to get a current status on claims (if you have any status indicated at all) and ensure that your system is now in sync with what the payers understand. C O N F I R M I N G P O S T I N G Another problem that can be very challenging to overcome is confirming the posting of payment information by the billing company, especially when there was no bank deposit reconciling against the posted item. If you re able to get the historical 835 files from the clearinghouse that the billing company was using, then you can upload those into your own clearinghouse and have them processed and published back into your practice management system. Doing this will bring your system up-to-date. In the worst case scenario, you ll have exported reports from the billing company indicating what has been received, and you ll then have to cross-reference those with each individual account on your system. It is possible to find some shortcuts for loading historical data where individual adjustments on charges may not get entered directly but do require summarized information about: - What was allowed - What was patient responsibility - What was paid Anywhere a denial occurred, you will want to capture related adjustment information whenever possible for working your accounts receivable. Otherwise you d be fruitlessly following a trail of denials and missing bank deposits.

13 A R C L E A N U P A major catalyst for leaving your billing company is that your accounts receivable has built up and your claims are timing out. Due to a lack of competence or follow through from your billing company, you know you haven t been receiving all possible payment from your claims. It s time to collect as much money as possible from your accounts receivable, for many reasons, including offsetting the transitional costs of bringing your billing back in-house.

14 O R G A N I Z I N G A R I N T O P R O J E C T S To manage your AR cleanup, first you'll need to organize your AR into discreet projects that can be focused on by one or more staff members. Then they can be isolated from a reporting standpoint to demonstrate their progress and track them through the cleanup process. This should allow your staff to work claims in batches, collecting multiple documents or updating multiple pieces of information all at the same time. W O R K B Y P A Y E R A N D T Y P E O F D E N I A L The best way to work your AR is to organize claims by payer and type so that within a single payer you are looking at all of the denials and can compare the reasons for those denials. These can be worked in conjunction. When your billing department inevitably needs to make phone calls to the payers, it's vital that your team inquires about multiple patient accounts and learns from the payer s responses so you can use that information when a denial of the same type and scenario occurs again. For example, if you can re-submit a claim with a modification, then you should be able to apply that change to all similar claims without having to call the payer for each one. Your billing department can also take the same approach for: - Appeals - Issues related to a coordination of benefits - Content requiring a claim attachment It's very important your team works in batches, by payer, whenever possible.

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16 M A N A G I N G Y O U R N E W W O R K F L O W Once you ve brought your billing back in house, it is crucial that your AR department organizes and manages workflow from start to finish through: The scheduling of an appointment - Registration - Coding - Billing - AR follow-up - Posting - Patient filling - Patient collections It's also key that you organize the roles and responsibilities of each staff member and the systems that need to be used in this process. There are always new opportunities to connect systems to automate functionality. In fact, many of the newer cloud-based systems and their partner bolt-on technologies can: Connect a variety of patient-facing and operational tools to limit the amount of data entry that your staff are doing Ensure that you're still working with real-time data Over time, you and your team will still need to continue overseeing and looking for opportunities to remove steps from the process and leverage various functions in newer software systems.

17 M A N A G I N G S T A F F One of the reasons you out sourced your billing is because you trusted the billing company staff to expertly manage your revenue cycle. The idea of hiring your own staff to manage revenue cycle felt daunting and expensive. One of the best ways to begin implementing revenue cycle processes into your staff is to hire at least one person that has deep experience with revenue cycle management from a billing, AR, and posting perspective. This one person can be your subject matter expert and help you set up the systems and processes and also assist in training other staff members in how to execute tasks. Oftentimes, an existing staff member can step into this role and be trained to perform billing and payment collection activities.

18 C R O S S T R A I N I N G Even with a team leader of sorts, each of your staff members should be cross-trained so they understand scheduling, registration, and how: - Charges are coded - Those charges get out the door on a claim - Rejections are identified in the clearinghouse and can be fixed - Claims are followed up with via claim status - Payments are interpreted and denials are interpreted - Denials are followed up on - Payments are posted - Patients are billed - Patients can pay Each of your staff members that work in the revenue cycle need to be cross-trained across these functions so they can fill in for each other and help out whenever someone gets behind. You don't want specialists that are so narrowly trained that theirs tasks can't be done by anybody else. W E E K L Y M E E T I N G S Maintaining ongoing communication about all components of the revenue cycle will be vital once you re doing your billing in-house again. But this endeavor doesn t have to take a huge bite out of the time needed for other work you need to do. A single hour-long meeting should be sufficient. These meetings will be very helpful for many reasons. For example, you ll be able to identify any issues that any one team member is running into. Typically, these issues will be clustered by payer and will require a follow-up with the payer representative to smooth things out. Within a single weekly meeting, you should be able to keep everyone on task, whether you have a staff of two or a staff of ten.

19 F E E D B A C K L O O P S A smart revenue cycle learns from itself. When a certain payer is denying payment for a given service under a certain condition, it's important that your team and your software understands the outcome of these actions. Usually, there are ways to prevent these denials by modifying the combination of services that are being performed and/or the setting in which they are being performed. The feedback from the denials that are coming in at the end of the revenue cycle should be vocalized and responded to by the front end of your practice. Because claims will get paid the first time around, this approach will continue to reduce: Unnecessary denials Delays in payment The amount of work your staff has to perform

20 P E R F O R M A N C E I M P R O V E M E N T Just like any operation, your in-house billing operation can be improved over time. There are several areas you can focus on that will increase payments and reduce accounts receivable.

21 S C R U B B I N G C L A I M S Scrubbing claims is a way of evaluating a claim before it goes to the payer to look for predictable problems. By looking at prior denied claims that were submitted under similar circumstances to a similar individual or set of payers, your team will eventually be able to predict these problems. Negative outcomes can also be used to train new team members and create rules on the front end that will help prevent claims with certain types of situations from going out the door in the first place. In a smaller provider operation, this may not be a major task. But in a larger group practice or ancillary service, establishing this system for scrubbing claims could be a major undertaking because the number of transactions or the information on those transactions may vary payer to payer. Regardless of the size of your medical business, you can set up rules in your clearinghouse or practice management system, but you may find that these systems lack the ability to look at complex situations. P A Y E R I N C E N T I V E S Payers develop a variety of programs that create opportunities for providers willing to participate in these programs. These may be referred to as upside risk-based programs or downside risk-based programs, and usually incorporate additional reporting of or submission of information on a claim to aid in the tracking process. Participating in these programs can be very challenging initially, but should allow your medical business to increase revenue over time. Additional tools that scrub data both before it goes out the door and after payment is received can help maintain compliance with these incentive programs, ensuring additional revenue for your practice.

22 F O L L O W U P A U T O M A T I O N Because following up on claims can be such a time-consuming process, it's vital you find opportunities to automate this process as much as possible. One major opportunity is claim status checks that automatically occur after a certain number of days to proactively identify a claim that has been pended by the payer. This way, instead of waiting for a denial to come in, your team will know very quickly if they need to submit additional documentation or follow-up in some other way. When doing this, you should to have follow-up information available so when you submit an attachment to a payer, it is already correctly connected to the claim that the payer has.

23 R E A C H O U T T O R C M B R A I N F O R H E L P B R I N G I N G Y O U R B I L L I N G B A C K I N H O U S E If you are ready to bring your billing back in house and want to ensure you do so successfully, enlist the RCM Brain ninjas today. We can help you grow your medical business and bring in more money through your accounts receivable department. To set up a consultation, call us at RCM-BETH or visit rcmbrain.com.