1
Presented by Yvonne Dailey CPC CPC-I ALL RIGHTS REVERED
Disclaimer The materials are offered as tools to assist the
participants in understanding their revenue cycle No part of the presentation may be reproduced or transmitted in any form or by any means (graphically electronically or mechanically including photocopying recording or taping) without the expressed written permission of Dailey Billing Services Inc
All Rights Reserved
Introduction Provider Practice as a ldquoBUSINESSrdquo Communication is Key Start of the Revenue Cycle Everyone has a Role and Responsibility Denial Management Timely Filing Guidelines and Corrective Claims Guidelines Getting the Patient Involved ndash Early Using New Technology ndash Offer Multiple Payment Options Using the Internet for Skip Trace Techniques Performing Written as Well as Oral Communication Small Claims vs Collections Agency
All Rights Reserved
2
Keeping The Pulse Alive The practice is a Business
Start off on the right foot
Financial Policy ndash Stick to it Set the rule on getting paid
Set up collection goals ndash weekly monthly quarterly annually
Know your surroundings
Get patients involved early
Offer different methods for payments
Know when to cut your losses
Know who you are contracted with ndash VERY important when scheduling
Medical Billing Process
What is YOUR Role in this Process Role Responsibilities
ReceptionistScheduler Schedules the patientrsquos appointment greets the patient verifies insurance amp eligibility Discusses insurance coverage with the patient
Provider Examines the patient Documents the patientrsquos condition and treatment plan in medical record
Medical Coder Interprets the medical record based on the documentation ndash depending on facility may add modifiers and procedures
3
What is YOUR Role in this Process Role Responsibilities
Charge Entry Clerk Biller Verifies the case information for accuracy for claim submission Submits claims
Payment Clerk Applies all payments received to patient account - THIS INCLUDES ZERO PAYMENT EOBS
Account Representive Researches all denialrejections processes all corrections resolves insurance billing or payment problems and establishes payment plan with patient
What is YOUR Role in this Process
Role Responsibilities
Administrator Generates and reviews reports for supporting the billing process These reports included daily weekly monthly quarterly and yearly tasks
Medical Billing Process Insurance Verification
The First Step ndash First Contact with Patient ndash Cycle Starts The MOST important step in process ndash Most Ignored Provider Network Inform Patient Up front New Patient vs Established Patient No Time Loss of Revenue Identify if prior authorizationprecertification andor
referral are needed ABN The Referring Provider What Questions to Ask
4
Medical Billing Process Insurance Verification Process
Questions to ask Does the patient have a deductible Has it been met Does the patient have co-insurance Whatrsquos the percentage
Does the patient have a co-pay How much is it
Start date and end date of coverage
Medical Billing Process Insurance Verification
Name the Following Carriers
1 W123458759_____________________
2 U410312358______________________
3 NJX3HZN44105___________________
4MEDBBDXE________________________
5 MA123456789_______________________
6123456789A ________________________
YLM81180650________________________
QFT111011236545______________________
Medical Billing Process Patient Demographics
Review intake form to ensure the information is accurate
Did the patient sign the financial policy
Make a copy of the insurance card ndash front and back
Make a copy of patient ID ndash front and back
Are ALL forms signed and dated
Collect co-pay deductible andor co-insurance
Update intake forms annually
Start and end dates for insurance carriers ndash REQUIRE IT
Review your returned mail
Review at each visit ndash review ID also for changes
5
Medical Billing Process CPT amp ICD 9 CODING
The coderrsquos responsibility is to review for accuracy
Never leave money on the table
Medical billing and coding is like a puzzle ndash all pieces must link together accordingly
Medical Necessity
Know your carrier guidelines and policies
Medical Billing Process CPT amp ICD 9 CODING
Letrsquos review the following examples Provider documented Flu shot The flu vaccine can be billed a number of ways Medicare (depending on your Medicare Carrier)
Q0236 ndash Flu Vaccine ( your Q code depends on the ACTUAL vaccine administered to patient) G0008 ndash Administration of Flu Vaccine
To bill a commercial carrier 90658 ndash Flu Vaccine 90471 ndash Administration of vaccine
Changes if it was the FluMist
This is a small sampling as there are multiple vaccine codes for the flu
Medical Billing Process CPT amp ICD 9 CODING
6
Medical Billing Process Charge Entry
Enter all charges
Review BEFORE submission
Based on the providerrsquos documentation
Review for lost revenue (administration supplies etc)
Samples of things to review
NPI referring provider information on set date DOB DOS
Know payer policies for what is billed
Know carrier timely guidelines
Are any modifiers needed
Medical Billing Process Charge Entry
Letrsquos review the sample charge ticket
How many billable charges are there
Is there anything missing
Will it require a modifier
Do you need a referring andor ordering provider
Does it make a difference if this is a Medicare pt or a Commercial pt Why or why not
Now letrsquos look at the 1500 for this claim
Medical Billing Process Charge Entry
7
Medical Billing Process Charge Entry
Medical Billing Process Claim Submission
Review and document your claim submissions
If your clearinghouse allows corrections on the site be sure to correct on your end also
Review your EDI reports daily
Know what reports are needed for appeals andor fighting your timely filing
Know your claim submission file (837 835 997 etc)
Medical Billing Process Payment Posting
All payments must be posted ndash EVEN your ZERO dollar EOBs and even if you are going to work the denialrejection post it
Know your denial codes such as CO50 CO45 PR204 etc
Use notes in your system ndash important
Document all communication with carriers ndash date time and person you spoke to
8
Medical Billing Process Payment Posting
Letrsquos review the following example
Par Dr Amt Billed
Pd at TOS
Carrier payment
Write off amount
Amt to bill pt
Difference
$200 $10 $100
Non Par
$200 $10 $100
Medical Billing Process AR Follow UP
Follow Up - Most important to manage the AR
Must be able to research and know where to search
Insurance Aging
Patient Aging
Work weekly monthly quarterly yearly
Pick up the phone ndash it still works
Document your follow up attempts notes letters phone calls etc
Medical Billing Process Denial Management
In many cases practice denials represent internal errors
Loss of revenue or delayed revenue
Track denials
Train staff on payer policies coding billing (your findings)
Monitor
Make staff members accountable
9
Medical Billing Process Denial Management
Know the difference between a denial and rejection
Letrsquos review denial code CO50
PR27
Which is a rejection and which is a denial
Understand how to read your EOBs
Just because the EOB states to write it off doesnrsquot always mean you write it off
APPEAL APPEAL APPEAL
Medical Billing Process Denial Management
Clearinghouse Dashboards
Gives complete summary (accepted denials)
Overview of your top rejections
Use as training tool
Share your findings with staff and providers
Inform provider not everything gets paid
Medical Billing Process Denial Management
10
Medical Billing Process Denial Management
Medical Billing Process Cost For NOT Working Denials
90 CLAIMS PER DAY AT $90 PER CLAIM = $8100
IF 10 DENIED = $810 IN DENIAL PER DAY
IF ONLY 1 IN 10 DENIALS ARE APPEALED IT =$72900 PER DAY
52 WEEKS X 5 DAYS ndash 20 DAY (VACATIONS AND HOLIDAYS) = 240 WORKING DAYS
240 DAYS X $72900 = $174960 LOST PER YEAR
Medical Billing Process Useful Reports
Practice Analysis
Insurance Aging (90 120 151)
Secondary Aging (medigap claims)
Procedure Analysis
Diagnosis Analysis
Patient Aging
Denial Report
Surgery Report
11
Timely Filing Guidelines Carrier Time Frame
United Health Care 90 Days from date of Service
Oxford 90 Days from Date of Service
Aetna 180 Days from Date of Service
Cigna 90 Days from Date of Service
Cigna Great West 15 months
Medicare 12 months (Calendar )
This will differ if the provider is NON PAR For example Cigna is 180 Days
Proof of Timely Filing Most carriers want your EDI reports to show claims
accepted and acknowledged by Payor
Some Carriers REQUIRE you use their forms to appeal
Itrsquos not enough to have an acceptance from your clearinghouse They want acknowledgement that THEY received it
If you mailed your claims then you should have mailed certified with return receipt
Corrective Claims Guidelines Carrier Time Frame
United Health Care 60 Days from date of remit
Oxford 60 Days from date of remit
Aetna 12 Months from date of remit
Cigna 180 Days from date of remit
Some may require that you use THEIR forms others may allow you to simply write a request Forms may vary depending on state where provider is located Should ALWAYS BE SENT CERTIFIED WITH RETURN RECEIPT Keep a file andor log so you can track
12
Reasons Patients DONrsquoT Pay Job loss reduced income
Emergency situations
Loss of insurance coverage
Hardship
Not understanding insurance plans
Wasnrsquot aware they owed
Killing The Awkward Silence Of Collecting Money
Kill it with kindness
Keep it simple keep it professional be assertive
Offer multiple payment options
Different Type of Collections Letters Financial Policy
Funds Were Paid To Patient
Past Due Notices (30 60 90)
Offering Different Payment Methods
No Payment Received By Carriers
Pre-Existing Clause
Insurance Verification Letter
Financial Hardship
13
The Cost To Collect A Copay Copay
Amount CashCheck
at time of service
Credit Card payment in
office
Billing the patient
Billing the patient TWICE
$2000 $0 ($2000) $96 ($1904) $300 (1700) $600 (1400)
Patient has been billed three times and NEVER Pays
- $2900
Different Payment Options Debit Cards
Credit Cards
Online AUTOMATIC withdrawals from checking or savings
Check
Cash
Via your website
Paypal
Online Bill Payment Merchant accounts now offer ways to pay by credit
card via the internet where the patient feels comfortable putting in their own information For example we use Netdeposit Set up direct payment out of their check savings and or credit card Taken out automatically monthly or bimonthly
( check payment online)
14
The Benefits Of Online Bill Payments Automatic debit from any account type
Recurring payment schedules
View payment history
View future payments
Archived payment receipts
Receipts emailed to both patient and practice
Payment scheduled is also emailed to patient and practice
Online Payment History
GENERAL TRANSACTION VIEW BEGINNING 02042013
Month Checks Ck Amt Credit Cards Credit Amt Total Rev
Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677
Skip Tracing Methods What is Skip Trace
Skip Trace Identifiers
Patientrsquos EXACT full name
Date of Birth or Age
Social Security Numbers
Previous Address ndash Last Known
Driverrsquos License Number
Insurance Policy Numbers
15
Skip Tracing Methods- Let Your Monthly
Statements Do the work For YOU
Use your Postal Service - Ancillary Service Endorsements
Return Service Requested
Temp-Return Service Requested
Address Service Requested
Change Service Requested
NCOA-Link services
Letting Monthly Statements Do The Work For YOU
NCOA-LINK
16
Internet Skip Trace Many different websites to assist you
www411com
wwwuspscom
wwwgooglecom
Other people search sites
The cost vary from $100 to $35000
Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People
Name Age Previous
Cities DOB Phone Address Avg Income
Avg Home
Value Relatives
1
Yvonne D
Dailey
38 Bradenton FL
Oneco FL
Randall T
Dailey (40)
Connie Y
Dailey (70)
Thomas M
Dailey (70)
Constance Y
Dailey (70)
William F
Dailey (36)
2
Yvonne D
Dailey
41
Long Branch
NJ
Albuquerque
NM
Toms River
NJ
Delroy A
Dailey (40)
Bill Dailey
Mr Dailey
3 Yvonne D
Dailey
52
Austin TX
Claremore
OK
Spicewood
TX
Camille
Yvonne
Dailey (52)
Jon Dailey
Perform written as well as oral communications Use the collection letters
Call the patient if over 60 days
Offer a payment plan and stick to it
Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place
17
Small Claims vs Collection Agency Know when to cut your losses and at what price
Regardless of route you use you will need to prove your collection efforts
Small claims will cost you the cost of court plus the attorney fee ndash Patients fear court
Collection Agency ndash negotiate your fees (28 to 45 of collections)
Questions Thank you for attending
How to contact us infodaileybillingcom
Yvonne Dailey CPCCPCI ydaileydaileybillingcom
Website wwwdaileybillingcom
Resources United States Postal Service wwwuspscom
Netdeposit ndash wwwnetdepositcom Online Merchant Vendor
Useful websites www411com wwwyellowbookcom
Example letters Yvonne Dailey-Dailey Billing Services wwwdaileybillingcom
2
Keeping The Pulse Alive The practice is a Business
Start off on the right foot
Financial Policy ndash Stick to it Set the rule on getting paid
Set up collection goals ndash weekly monthly quarterly annually
Know your surroundings
Get patients involved early
Offer different methods for payments
Know when to cut your losses
Know who you are contracted with ndash VERY important when scheduling
Medical Billing Process
What is YOUR Role in this Process Role Responsibilities
ReceptionistScheduler Schedules the patientrsquos appointment greets the patient verifies insurance amp eligibility Discusses insurance coverage with the patient
Provider Examines the patient Documents the patientrsquos condition and treatment plan in medical record
Medical Coder Interprets the medical record based on the documentation ndash depending on facility may add modifiers and procedures
3
What is YOUR Role in this Process Role Responsibilities
Charge Entry Clerk Biller Verifies the case information for accuracy for claim submission Submits claims
Payment Clerk Applies all payments received to patient account - THIS INCLUDES ZERO PAYMENT EOBS
Account Representive Researches all denialrejections processes all corrections resolves insurance billing or payment problems and establishes payment plan with patient
What is YOUR Role in this Process
Role Responsibilities
Administrator Generates and reviews reports for supporting the billing process These reports included daily weekly monthly quarterly and yearly tasks
Medical Billing Process Insurance Verification
The First Step ndash First Contact with Patient ndash Cycle Starts The MOST important step in process ndash Most Ignored Provider Network Inform Patient Up front New Patient vs Established Patient No Time Loss of Revenue Identify if prior authorizationprecertification andor
referral are needed ABN The Referring Provider What Questions to Ask
4
Medical Billing Process Insurance Verification Process
Questions to ask Does the patient have a deductible Has it been met Does the patient have co-insurance Whatrsquos the percentage
Does the patient have a co-pay How much is it
Start date and end date of coverage
Medical Billing Process Insurance Verification
Name the Following Carriers
1 W123458759_____________________
2 U410312358______________________
3 NJX3HZN44105___________________
4MEDBBDXE________________________
5 MA123456789_______________________
6123456789A ________________________
YLM81180650________________________
QFT111011236545______________________
Medical Billing Process Patient Demographics
Review intake form to ensure the information is accurate
Did the patient sign the financial policy
Make a copy of the insurance card ndash front and back
Make a copy of patient ID ndash front and back
Are ALL forms signed and dated
Collect co-pay deductible andor co-insurance
Update intake forms annually
Start and end dates for insurance carriers ndash REQUIRE IT
Review your returned mail
Review at each visit ndash review ID also for changes
5
Medical Billing Process CPT amp ICD 9 CODING
The coderrsquos responsibility is to review for accuracy
Never leave money on the table
Medical billing and coding is like a puzzle ndash all pieces must link together accordingly
Medical Necessity
Know your carrier guidelines and policies
Medical Billing Process CPT amp ICD 9 CODING
Letrsquos review the following examples Provider documented Flu shot The flu vaccine can be billed a number of ways Medicare (depending on your Medicare Carrier)
Q0236 ndash Flu Vaccine ( your Q code depends on the ACTUAL vaccine administered to patient) G0008 ndash Administration of Flu Vaccine
To bill a commercial carrier 90658 ndash Flu Vaccine 90471 ndash Administration of vaccine
Changes if it was the FluMist
This is a small sampling as there are multiple vaccine codes for the flu
Medical Billing Process CPT amp ICD 9 CODING
6
Medical Billing Process Charge Entry
Enter all charges
Review BEFORE submission
Based on the providerrsquos documentation
Review for lost revenue (administration supplies etc)
Samples of things to review
NPI referring provider information on set date DOB DOS
Know payer policies for what is billed
Know carrier timely guidelines
Are any modifiers needed
Medical Billing Process Charge Entry
Letrsquos review the sample charge ticket
How many billable charges are there
Is there anything missing
Will it require a modifier
Do you need a referring andor ordering provider
Does it make a difference if this is a Medicare pt or a Commercial pt Why or why not
Now letrsquos look at the 1500 for this claim
Medical Billing Process Charge Entry
7
Medical Billing Process Charge Entry
Medical Billing Process Claim Submission
Review and document your claim submissions
If your clearinghouse allows corrections on the site be sure to correct on your end also
Review your EDI reports daily
Know what reports are needed for appeals andor fighting your timely filing
Know your claim submission file (837 835 997 etc)
Medical Billing Process Payment Posting
All payments must be posted ndash EVEN your ZERO dollar EOBs and even if you are going to work the denialrejection post it
Know your denial codes such as CO50 CO45 PR204 etc
Use notes in your system ndash important
Document all communication with carriers ndash date time and person you spoke to
8
Medical Billing Process Payment Posting
Letrsquos review the following example
Par Dr Amt Billed
Pd at TOS
Carrier payment
Write off amount
Amt to bill pt
Difference
$200 $10 $100
Non Par
$200 $10 $100
Medical Billing Process AR Follow UP
Follow Up - Most important to manage the AR
Must be able to research and know where to search
Insurance Aging
Patient Aging
Work weekly monthly quarterly yearly
Pick up the phone ndash it still works
Document your follow up attempts notes letters phone calls etc
Medical Billing Process Denial Management
In many cases practice denials represent internal errors
Loss of revenue or delayed revenue
Track denials
Train staff on payer policies coding billing (your findings)
Monitor
Make staff members accountable
9
Medical Billing Process Denial Management
Know the difference between a denial and rejection
Letrsquos review denial code CO50
PR27
Which is a rejection and which is a denial
Understand how to read your EOBs
Just because the EOB states to write it off doesnrsquot always mean you write it off
APPEAL APPEAL APPEAL
Medical Billing Process Denial Management
Clearinghouse Dashboards
Gives complete summary (accepted denials)
Overview of your top rejections
Use as training tool
Share your findings with staff and providers
Inform provider not everything gets paid
Medical Billing Process Denial Management
10
Medical Billing Process Denial Management
Medical Billing Process Cost For NOT Working Denials
90 CLAIMS PER DAY AT $90 PER CLAIM = $8100
IF 10 DENIED = $810 IN DENIAL PER DAY
IF ONLY 1 IN 10 DENIALS ARE APPEALED IT =$72900 PER DAY
52 WEEKS X 5 DAYS ndash 20 DAY (VACATIONS AND HOLIDAYS) = 240 WORKING DAYS
240 DAYS X $72900 = $174960 LOST PER YEAR
Medical Billing Process Useful Reports
Practice Analysis
Insurance Aging (90 120 151)
Secondary Aging (medigap claims)
Procedure Analysis
Diagnosis Analysis
Patient Aging
Denial Report
Surgery Report
11
Timely Filing Guidelines Carrier Time Frame
United Health Care 90 Days from date of Service
Oxford 90 Days from Date of Service
Aetna 180 Days from Date of Service
Cigna 90 Days from Date of Service
Cigna Great West 15 months
Medicare 12 months (Calendar )
This will differ if the provider is NON PAR For example Cigna is 180 Days
Proof of Timely Filing Most carriers want your EDI reports to show claims
accepted and acknowledged by Payor
Some Carriers REQUIRE you use their forms to appeal
Itrsquos not enough to have an acceptance from your clearinghouse They want acknowledgement that THEY received it
If you mailed your claims then you should have mailed certified with return receipt
Corrective Claims Guidelines Carrier Time Frame
United Health Care 60 Days from date of remit
Oxford 60 Days from date of remit
Aetna 12 Months from date of remit
Cigna 180 Days from date of remit
Some may require that you use THEIR forms others may allow you to simply write a request Forms may vary depending on state where provider is located Should ALWAYS BE SENT CERTIFIED WITH RETURN RECEIPT Keep a file andor log so you can track
12
Reasons Patients DONrsquoT Pay Job loss reduced income
Emergency situations
Loss of insurance coverage
Hardship
Not understanding insurance plans
Wasnrsquot aware they owed
Killing The Awkward Silence Of Collecting Money
Kill it with kindness
Keep it simple keep it professional be assertive
Offer multiple payment options
Different Type of Collections Letters Financial Policy
Funds Were Paid To Patient
Past Due Notices (30 60 90)
Offering Different Payment Methods
No Payment Received By Carriers
Pre-Existing Clause
Insurance Verification Letter
Financial Hardship
13
The Cost To Collect A Copay Copay
Amount CashCheck
at time of service
Credit Card payment in
office
Billing the patient
Billing the patient TWICE
$2000 $0 ($2000) $96 ($1904) $300 (1700) $600 (1400)
Patient has been billed three times and NEVER Pays
- $2900
Different Payment Options Debit Cards
Credit Cards
Online AUTOMATIC withdrawals from checking or savings
Check
Cash
Via your website
Paypal
Online Bill Payment Merchant accounts now offer ways to pay by credit
card via the internet where the patient feels comfortable putting in their own information For example we use Netdeposit Set up direct payment out of their check savings and or credit card Taken out automatically monthly or bimonthly
( check payment online)
14
The Benefits Of Online Bill Payments Automatic debit from any account type
Recurring payment schedules
View payment history
View future payments
Archived payment receipts
Receipts emailed to both patient and practice
Payment scheduled is also emailed to patient and practice
Online Payment History
GENERAL TRANSACTION VIEW BEGINNING 02042013
Month Checks Ck Amt Credit Cards Credit Amt Total Rev
Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677
Skip Tracing Methods What is Skip Trace
Skip Trace Identifiers
Patientrsquos EXACT full name
Date of Birth or Age
Social Security Numbers
Previous Address ndash Last Known
Driverrsquos License Number
Insurance Policy Numbers
15
Skip Tracing Methods- Let Your Monthly
Statements Do the work For YOU
Use your Postal Service - Ancillary Service Endorsements
Return Service Requested
Temp-Return Service Requested
Address Service Requested
Change Service Requested
NCOA-Link services
Letting Monthly Statements Do The Work For YOU
NCOA-LINK
16
Internet Skip Trace Many different websites to assist you
www411com
wwwuspscom
wwwgooglecom
Other people search sites
The cost vary from $100 to $35000
Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People
Name Age Previous
Cities DOB Phone Address Avg Income
Avg Home
Value Relatives
1
Yvonne D
Dailey
38 Bradenton FL
Oneco FL
Randall T
Dailey (40)
Connie Y
Dailey (70)
Thomas M
Dailey (70)
Constance Y
Dailey (70)
William F
Dailey (36)
2
Yvonne D
Dailey
41
Long Branch
NJ
Albuquerque
NM
Toms River
NJ
Delroy A
Dailey (40)
Bill Dailey
Mr Dailey
3 Yvonne D
Dailey
52
Austin TX
Claremore
OK
Spicewood
TX
Camille
Yvonne
Dailey (52)
Jon Dailey
Perform written as well as oral communications Use the collection letters
Call the patient if over 60 days
Offer a payment plan and stick to it
Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place
17
Small Claims vs Collection Agency Know when to cut your losses and at what price
Regardless of route you use you will need to prove your collection efforts
Small claims will cost you the cost of court plus the attorney fee ndash Patients fear court
Collection Agency ndash negotiate your fees (28 to 45 of collections)
Questions Thank you for attending
How to contact us infodaileybillingcom
Yvonne Dailey CPCCPCI ydaileydaileybillingcom
Website wwwdaileybillingcom
Resources United States Postal Service wwwuspscom
Netdeposit ndash wwwnetdepositcom Online Merchant Vendor
Useful websites www411com wwwyellowbookcom
Example letters Yvonne Dailey-Dailey Billing Services wwwdaileybillingcom
3
What is YOUR Role in this Process Role Responsibilities
Charge Entry Clerk Biller Verifies the case information for accuracy for claim submission Submits claims
Payment Clerk Applies all payments received to patient account - THIS INCLUDES ZERO PAYMENT EOBS
Account Representive Researches all denialrejections processes all corrections resolves insurance billing or payment problems and establishes payment plan with patient
What is YOUR Role in this Process
Role Responsibilities
Administrator Generates and reviews reports for supporting the billing process These reports included daily weekly monthly quarterly and yearly tasks
Medical Billing Process Insurance Verification
The First Step ndash First Contact with Patient ndash Cycle Starts The MOST important step in process ndash Most Ignored Provider Network Inform Patient Up front New Patient vs Established Patient No Time Loss of Revenue Identify if prior authorizationprecertification andor
referral are needed ABN The Referring Provider What Questions to Ask
4
Medical Billing Process Insurance Verification Process
Questions to ask Does the patient have a deductible Has it been met Does the patient have co-insurance Whatrsquos the percentage
Does the patient have a co-pay How much is it
Start date and end date of coverage
Medical Billing Process Insurance Verification
Name the Following Carriers
1 W123458759_____________________
2 U410312358______________________
3 NJX3HZN44105___________________
4MEDBBDXE________________________
5 MA123456789_______________________
6123456789A ________________________
YLM81180650________________________
QFT111011236545______________________
Medical Billing Process Patient Demographics
Review intake form to ensure the information is accurate
Did the patient sign the financial policy
Make a copy of the insurance card ndash front and back
Make a copy of patient ID ndash front and back
Are ALL forms signed and dated
Collect co-pay deductible andor co-insurance
Update intake forms annually
Start and end dates for insurance carriers ndash REQUIRE IT
Review your returned mail
Review at each visit ndash review ID also for changes
5
Medical Billing Process CPT amp ICD 9 CODING
The coderrsquos responsibility is to review for accuracy
Never leave money on the table
Medical billing and coding is like a puzzle ndash all pieces must link together accordingly
Medical Necessity
Know your carrier guidelines and policies
Medical Billing Process CPT amp ICD 9 CODING
Letrsquos review the following examples Provider documented Flu shot The flu vaccine can be billed a number of ways Medicare (depending on your Medicare Carrier)
Q0236 ndash Flu Vaccine ( your Q code depends on the ACTUAL vaccine administered to patient) G0008 ndash Administration of Flu Vaccine
To bill a commercial carrier 90658 ndash Flu Vaccine 90471 ndash Administration of vaccine
Changes if it was the FluMist
This is a small sampling as there are multiple vaccine codes for the flu
Medical Billing Process CPT amp ICD 9 CODING
6
Medical Billing Process Charge Entry
Enter all charges
Review BEFORE submission
Based on the providerrsquos documentation
Review for lost revenue (administration supplies etc)
Samples of things to review
NPI referring provider information on set date DOB DOS
Know payer policies for what is billed
Know carrier timely guidelines
Are any modifiers needed
Medical Billing Process Charge Entry
Letrsquos review the sample charge ticket
How many billable charges are there
Is there anything missing
Will it require a modifier
Do you need a referring andor ordering provider
Does it make a difference if this is a Medicare pt or a Commercial pt Why or why not
Now letrsquos look at the 1500 for this claim
Medical Billing Process Charge Entry
7
Medical Billing Process Charge Entry
Medical Billing Process Claim Submission
Review and document your claim submissions
If your clearinghouse allows corrections on the site be sure to correct on your end also
Review your EDI reports daily
Know what reports are needed for appeals andor fighting your timely filing
Know your claim submission file (837 835 997 etc)
Medical Billing Process Payment Posting
All payments must be posted ndash EVEN your ZERO dollar EOBs and even if you are going to work the denialrejection post it
Know your denial codes such as CO50 CO45 PR204 etc
Use notes in your system ndash important
Document all communication with carriers ndash date time and person you spoke to
8
Medical Billing Process Payment Posting
Letrsquos review the following example
Par Dr Amt Billed
Pd at TOS
Carrier payment
Write off amount
Amt to bill pt
Difference
$200 $10 $100
Non Par
$200 $10 $100
Medical Billing Process AR Follow UP
Follow Up - Most important to manage the AR
Must be able to research and know where to search
Insurance Aging
Patient Aging
Work weekly monthly quarterly yearly
Pick up the phone ndash it still works
Document your follow up attempts notes letters phone calls etc
Medical Billing Process Denial Management
In many cases practice denials represent internal errors
Loss of revenue or delayed revenue
Track denials
Train staff on payer policies coding billing (your findings)
Monitor
Make staff members accountable
9
Medical Billing Process Denial Management
Know the difference between a denial and rejection
Letrsquos review denial code CO50
PR27
Which is a rejection and which is a denial
Understand how to read your EOBs
Just because the EOB states to write it off doesnrsquot always mean you write it off
APPEAL APPEAL APPEAL
Medical Billing Process Denial Management
Clearinghouse Dashboards
Gives complete summary (accepted denials)
Overview of your top rejections
Use as training tool
Share your findings with staff and providers
Inform provider not everything gets paid
Medical Billing Process Denial Management
10
Medical Billing Process Denial Management
Medical Billing Process Cost For NOT Working Denials
90 CLAIMS PER DAY AT $90 PER CLAIM = $8100
IF 10 DENIED = $810 IN DENIAL PER DAY
IF ONLY 1 IN 10 DENIALS ARE APPEALED IT =$72900 PER DAY
52 WEEKS X 5 DAYS ndash 20 DAY (VACATIONS AND HOLIDAYS) = 240 WORKING DAYS
240 DAYS X $72900 = $174960 LOST PER YEAR
Medical Billing Process Useful Reports
Practice Analysis
Insurance Aging (90 120 151)
Secondary Aging (medigap claims)
Procedure Analysis
Diagnosis Analysis
Patient Aging
Denial Report
Surgery Report
11
Timely Filing Guidelines Carrier Time Frame
United Health Care 90 Days from date of Service
Oxford 90 Days from Date of Service
Aetna 180 Days from Date of Service
Cigna 90 Days from Date of Service
Cigna Great West 15 months
Medicare 12 months (Calendar )
This will differ if the provider is NON PAR For example Cigna is 180 Days
Proof of Timely Filing Most carriers want your EDI reports to show claims
accepted and acknowledged by Payor
Some Carriers REQUIRE you use their forms to appeal
Itrsquos not enough to have an acceptance from your clearinghouse They want acknowledgement that THEY received it
If you mailed your claims then you should have mailed certified with return receipt
Corrective Claims Guidelines Carrier Time Frame
United Health Care 60 Days from date of remit
Oxford 60 Days from date of remit
Aetna 12 Months from date of remit
Cigna 180 Days from date of remit
Some may require that you use THEIR forms others may allow you to simply write a request Forms may vary depending on state where provider is located Should ALWAYS BE SENT CERTIFIED WITH RETURN RECEIPT Keep a file andor log so you can track
12
Reasons Patients DONrsquoT Pay Job loss reduced income
Emergency situations
Loss of insurance coverage
Hardship
Not understanding insurance plans
Wasnrsquot aware they owed
Killing The Awkward Silence Of Collecting Money
Kill it with kindness
Keep it simple keep it professional be assertive
Offer multiple payment options
Different Type of Collections Letters Financial Policy
Funds Were Paid To Patient
Past Due Notices (30 60 90)
Offering Different Payment Methods
No Payment Received By Carriers
Pre-Existing Clause
Insurance Verification Letter
Financial Hardship
13
The Cost To Collect A Copay Copay
Amount CashCheck
at time of service
Credit Card payment in
office
Billing the patient
Billing the patient TWICE
$2000 $0 ($2000) $96 ($1904) $300 (1700) $600 (1400)
Patient has been billed three times and NEVER Pays
- $2900
Different Payment Options Debit Cards
Credit Cards
Online AUTOMATIC withdrawals from checking or savings
Check
Cash
Via your website
Paypal
Online Bill Payment Merchant accounts now offer ways to pay by credit
card via the internet where the patient feels comfortable putting in their own information For example we use Netdeposit Set up direct payment out of their check savings and or credit card Taken out automatically monthly or bimonthly
( check payment online)
14
The Benefits Of Online Bill Payments Automatic debit from any account type
Recurring payment schedules
View payment history
View future payments
Archived payment receipts
Receipts emailed to both patient and practice
Payment scheduled is also emailed to patient and practice
Online Payment History
GENERAL TRANSACTION VIEW BEGINNING 02042013
Month Checks Ck Amt Credit Cards Credit Amt Total Rev
Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677
Skip Tracing Methods What is Skip Trace
Skip Trace Identifiers
Patientrsquos EXACT full name
Date of Birth or Age
Social Security Numbers
Previous Address ndash Last Known
Driverrsquos License Number
Insurance Policy Numbers
15
Skip Tracing Methods- Let Your Monthly
Statements Do the work For YOU
Use your Postal Service - Ancillary Service Endorsements
Return Service Requested
Temp-Return Service Requested
Address Service Requested
Change Service Requested
NCOA-Link services
Letting Monthly Statements Do The Work For YOU
NCOA-LINK
16
Internet Skip Trace Many different websites to assist you
www411com
wwwuspscom
wwwgooglecom
Other people search sites
The cost vary from $100 to $35000
Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People
Name Age Previous
Cities DOB Phone Address Avg Income
Avg Home
Value Relatives
1
Yvonne D
Dailey
38 Bradenton FL
Oneco FL
Randall T
Dailey (40)
Connie Y
Dailey (70)
Thomas M
Dailey (70)
Constance Y
Dailey (70)
William F
Dailey (36)
2
Yvonne D
Dailey
41
Long Branch
NJ
Albuquerque
NM
Toms River
NJ
Delroy A
Dailey (40)
Bill Dailey
Mr Dailey
3 Yvonne D
Dailey
52
Austin TX
Claremore
OK
Spicewood
TX
Camille
Yvonne
Dailey (52)
Jon Dailey
Perform written as well as oral communications Use the collection letters
Call the patient if over 60 days
Offer a payment plan and stick to it
Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place
17
Small Claims vs Collection Agency Know when to cut your losses and at what price
Regardless of route you use you will need to prove your collection efforts
Small claims will cost you the cost of court plus the attorney fee ndash Patients fear court
Collection Agency ndash negotiate your fees (28 to 45 of collections)
Questions Thank you for attending
How to contact us infodaileybillingcom
Yvonne Dailey CPCCPCI ydaileydaileybillingcom
Website wwwdaileybillingcom
Resources United States Postal Service wwwuspscom
Netdeposit ndash wwwnetdepositcom Online Merchant Vendor
Useful websites www411com wwwyellowbookcom
Example letters Yvonne Dailey-Dailey Billing Services wwwdaileybillingcom
4
Medical Billing Process Insurance Verification Process
Questions to ask Does the patient have a deductible Has it been met Does the patient have co-insurance Whatrsquos the percentage
Does the patient have a co-pay How much is it
Start date and end date of coverage
Medical Billing Process Insurance Verification
Name the Following Carriers
1 W123458759_____________________
2 U410312358______________________
3 NJX3HZN44105___________________
4MEDBBDXE________________________
5 MA123456789_______________________
6123456789A ________________________
YLM81180650________________________
QFT111011236545______________________
Medical Billing Process Patient Demographics
Review intake form to ensure the information is accurate
Did the patient sign the financial policy
Make a copy of the insurance card ndash front and back
Make a copy of patient ID ndash front and back
Are ALL forms signed and dated
Collect co-pay deductible andor co-insurance
Update intake forms annually
Start and end dates for insurance carriers ndash REQUIRE IT
Review your returned mail
Review at each visit ndash review ID also for changes
5
Medical Billing Process CPT amp ICD 9 CODING
The coderrsquos responsibility is to review for accuracy
Never leave money on the table
Medical billing and coding is like a puzzle ndash all pieces must link together accordingly
Medical Necessity
Know your carrier guidelines and policies
Medical Billing Process CPT amp ICD 9 CODING
Letrsquos review the following examples Provider documented Flu shot The flu vaccine can be billed a number of ways Medicare (depending on your Medicare Carrier)
Q0236 ndash Flu Vaccine ( your Q code depends on the ACTUAL vaccine administered to patient) G0008 ndash Administration of Flu Vaccine
To bill a commercial carrier 90658 ndash Flu Vaccine 90471 ndash Administration of vaccine
Changes if it was the FluMist
This is a small sampling as there are multiple vaccine codes for the flu
Medical Billing Process CPT amp ICD 9 CODING
6
Medical Billing Process Charge Entry
Enter all charges
Review BEFORE submission
Based on the providerrsquos documentation
Review for lost revenue (administration supplies etc)
Samples of things to review
NPI referring provider information on set date DOB DOS
Know payer policies for what is billed
Know carrier timely guidelines
Are any modifiers needed
Medical Billing Process Charge Entry
Letrsquos review the sample charge ticket
How many billable charges are there
Is there anything missing
Will it require a modifier
Do you need a referring andor ordering provider
Does it make a difference if this is a Medicare pt or a Commercial pt Why or why not
Now letrsquos look at the 1500 for this claim
Medical Billing Process Charge Entry
7
Medical Billing Process Charge Entry
Medical Billing Process Claim Submission
Review and document your claim submissions
If your clearinghouse allows corrections on the site be sure to correct on your end also
Review your EDI reports daily
Know what reports are needed for appeals andor fighting your timely filing
Know your claim submission file (837 835 997 etc)
Medical Billing Process Payment Posting
All payments must be posted ndash EVEN your ZERO dollar EOBs and even if you are going to work the denialrejection post it
Know your denial codes such as CO50 CO45 PR204 etc
Use notes in your system ndash important
Document all communication with carriers ndash date time and person you spoke to
8
Medical Billing Process Payment Posting
Letrsquos review the following example
Par Dr Amt Billed
Pd at TOS
Carrier payment
Write off amount
Amt to bill pt
Difference
$200 $10 $100
Non Par
$200 $10 $100
Medical Billing Process AR Follow UP
Follow Up - Most important to manage the AR
Must be able to research and know where to search
Insurance Aging
Patient Aging
Work weekly monthly quarterly yearly
Pick up the phone ndash it still works
Document your follow up attempts notes letters phone calls etc
Medical Billing Process Denial Management
In many cases practice denials represent internal errors
Loss of revenue or delayed revenue
Track denials
Train staff on payer policies coding billing (your findings)
Monitor
Make staff members accountable
9
Medical Billing Process Denial Management
Know the difference between a denial and rejection
Letrsquos review denial code CO50
PR27
Which is a rejection and which is a denial
Understand how to read your EOBs
Just because the EOB states to write it off doesnrsquot always mean you write it off
APPEAL APPEAL APPEAL
Medical Billing Process Denial Management
Clearinghouse Dashboards
Gives complete summary (accepted denials)
Overview of your top rejections
Use as training tool
Share your findings with staff and providers
Inform provider not everything gets paid
Medical Billing Process Denial Management
10
Medical Billing Process Denial Management
Medical Billing Process Cost For NOT Working Denials
90 CLAIMS PER DAY AT $90 PER CLAIM = $8100
IF 10 DENIED = $810 IN DENIAL PER DAY
IF ONLY 1 IN 10 DENIALS ARE APPEALED IT =$72900 PER DAY
52 WEEKS X 5 DAYS ndash 20 DAY (VACATIONS AND HOLIDAYS) = 240 WORKING DAYS
240 DAYS X $72900 = $174960 LOST PER YEAR
Medical Billing Process Useful Reports
Practice Analysis
Insurance Aging (90 120 151)
Secondary Aging (medigap claims)
Procedure Analysis
Diagnosis Analysis
Patient Aging
Denial Report
Surgery Report
11
Timely Filing Guidelines Carrier Time Frame
United Health Care 90 Days from date of Service
Oxford 90 Days from Date of Service
Aetna 180 Days from Date of Service
Cigna 90 Days from Date of Service
Cigna Great West 15 months
Medicare 12 months (Calendar )
This will differ if the provider is NON PAR For example Cigna is 180 Days
Proof of Timely Filing Most carriers want your EDI reports to show claims
accepted and acknowledged by Payor
Some Carriers REQUIRE you use their forms to appeal
Itrsquos not enough to have an acceptance from your clearinghouse They want acknowledgement that THEY received it
If you mailed your claims then you should have mailed certified with return receipt
Corrective Claims Guidelines Carrier Time Frame
United Health Care 60 Days from date of remit
Oxford 60 Days from date of remit
Aetna 12 Months from date of remit
Cigna 180 Days from date of remit
Some may require that you use THEIR forms others may allow you to simply write a request Forms may vary depending on state where provider is located Should ALWAYS BE SENT CERTIFIED WITH RETURN RECEIPT Keep a file andor log so you can track
12
Reasons Patients DONrsquoT Pay Job loss reduced income
Emergency situations
Loss of insurance coverage
Hardship
Not understanding insurance plans
Wasnrsquot aware they owed
Killing The Awkward Silence Of Collecting Money
Kill it with kindness
Keep it simple keep it professional be assertive
Offer multiple payment options
Different Type of Collections Letters Financial Policy
Funds Were Paid To Patient
Past Due Notices (30 60 90)
Offering Different Payment Methods
No Payment Received By Carriers
Pre-Existing Clause
Insurance Verification Letter
Financial Hardship
13
The Cost To Collect A Copay Copay
Amount CashCheck
at time of service
Credit Card payment in
office
Billing the patient
Billing the patient TWICE
$2000 $0 ($2000) $96 ($1904) $300 (1700) $600 (1400)
Patient has been billed three times and NEVER Pays
- $2900
Different Payment Options Debit Cards
Credit Cards
Online AUTOMATIC withdrawals from checking or savings
Check
Cash
Via your website
Paypal
Online Bill Payment Merchant accounts now offer ways to pay by credit
card via the internet where the patient feels comfortable putting in their own information For example we use Netdeposit Set up direct payment out of their check savings and or credit card Taken out automatically monthly or bimonthly
( check payment online)
14
The Benefits Of Online Bill Payments Automatic debit from any account type
Recurring payment schedules
View payment history
View future payments
Archived payment receipts
Receipts emailed to both patient and practice
Payment scheduled is also emailed to patient and practice
Online Payment History
GENERAL TRANSACTION VIEW BEGINNING 02042013
Month Checks Ck Amt Credit Cards Credit Amt Total Rev
Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677
Skip Tracing Methods What is Skip Trace
Skip Trace Identifiers
Patientrsquos EXACT full name
Date of Birth or Age
Social Security Numbers
Previous Address ndash Last Known
Driverrsquos License Number
Insurance Policy Numbers
15
Skip Tracing Methods- Let Your Monthly
Statements Do the work For YOU
Use your Postal Service - Ancillary Service Endorsements
Return Service Requested
Temp-Return Service Requested
Address Service Requested
Change Service Requested
NCOA-Link services
Letting Monthly Statements Do The Work For YOU
NCOA-LINK
16
Internet Skip Trace Many different websites to assist you
www411com
wwwuspscom
wwwgooglecom
Other people search sites
The cost vary from $100 to $35000
Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People
Name Age Previous
Cities DOB Phone Address Avg Income
Avg Home
Value Relatives
1
Yvonne D
Dailey
38 Bradenton FL
Oneco FL
Randall T
Dailey (40)
Connie Y
Dailey (70)
Thomas M
Dailey (70)
Constance Y
Dailey (70)
William F
Dailey (36)
2
Yvonne D
Dailey
41
Long Branch
NJ
Albuquerque
NM
Toms River
NJ
Delroy A
Dailey (40)
Bill Dailey
Mr Dailey
3 Yvonne D
Dailey
52
Austin TX
Claremore
OK
Spicewood
TX
Camille
Yvonne
Dailey (52)
Jon Dailey
Perform written as well as oral communications Use the collection letters
Call the patient if over 60 days
Offer a payment plan and stick to it
Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place
17
Small Claims vs Collection Agency Know when to cut your losses and at what price
Regardless of route you use you will need to prove your collection efforts
Small claims will cost you the cost of court plus the attorney fee ndash Patients fear court
Collection Agency ndash negotiate your fees (28 to 45 of collections)
Questions Thank you for attending
How to contact us infodaileybillingcom
Yvonne Dailey CPCCPCI ydaileydaileybillingcom
Website wwwdaileybillingcom
Resources United States Postal Service wwwuspscom
Netdeposit ndash wwwnetdepositcom Online Merchant Vendor
Useful websites www411com wwwyellowbookcom
Example letters Yvonne Dailey-Dailey Billing Services wwwdaileybillingcom
5
Medical Billing Process CPT amp ICD 9 CODING
The coderrsquos responsibility is to review for accuracy
Never leave money on the table
Medical billing and coding is like a puzzle ndash all pieces must link together accordingly
Medical Necessity
Know your carrier guidelines and policies
Medical Billing Process CPT amp ICD 9 CODING
Letrsquos review the following examples Provider documented Flu shot The flu vaccine can be billed a number of ways Medicare (depending on your Medicare Carrier)
Q0236 ndash Flu Vaccine ( your Q code depends on the ACTUAL vaccine administered to patient) G0008 ndash Administration of Flu Vaccine
To bill a commercial carrier 90658 ndash Flu Vaccine 90471 ndash Administration of vaccine
Changes if it was the FluMist
This is a small sampling as there are multiple vaccine codes for the flu
Medical Billing Process CPT amp ICD 9 CODING
6
Medical Billing Process Charge Entry
Enter all charges
Review BEFORE submission
Based on the providerrsquos documentation
Review for lost revenue (administration supplies etc)
Samples of things to review
NPI referring provider information on set date DOB DOS
Know payer policies for what is billed
Know carrier timely guidelines
Are any modifiers needed
Medical Billing Process Charge Entry
Letrsquos review the sample charge ticket
How many billable charges are there
Is there anything missing
Will it require a modifier
Do you need a referring andor ordering provider
Does it make a difference if this is a Medicare pt or a Commercial pt Why or why not
Now letrsquos look at the 1500 for this claim
Medical Billing Process Charge Entry
7
Medical Billing Process Charge Entry
Medical Billing Process Claim Submission
Review and document your claim submissions
If your clearinghouse allows corrections on the site be sure to correct on your end also
Review your EDI reports daily
Know what reports are needed for appeals andor fighting your timely filing
Know your claim submission file (837 835 997 etc)
Medical Billing Process Payment Posting
All payments must be posted ndash EVEN your ZERO dollar EOBs and even if you are going to work the denialrejection post it
Know your denial codes such as CO50 CO45 PR204 etc
Use notes in your system ndash important
Document all communication with carriers ndash date time and person you spoke to
8
Medical Billing Process Payment Posting
Letrsquos review the following example
Par Dr Amt Billed
Pd at TOS
Carrier payment
Write off amount
Amt to bill pt
Difference
$200 $10 $100
Non Par
$200 $10 $100
Medical Billing Process AR Follow UP
Follow Up - Most important to manage the AR
Must be able to research and know where to search
Insurance Aging
Patient Aging
Work weekly monthly quarterly yearly
Pick up the phone ndash it still works
Document your follow up attempts notes letters phone calls etc
Medical Billing Process Denial Management
In many cases practice denials represent internal errors
Loss of revenue or delayed revenue
Track denials
Train staff on payer policies coding billing (your findings)
Monitor
Make staff members accountable
9
Medical Billing Process Denial Management
Know the difference between a denial and rejection
Letrsquos review denial code CO50
PR27
Which is a rejection and which is a denial
Understand how to read your EOBs
Just because the EOB states to write it off doesnrsquot always mean you write it off
APPEAL APPEAL APPEAL
Medical Billing Process Denial Management
Clearinghouse Dashboards
Gives complete summary (accepted denials)
Overview of your top rejections
Use as training tool
Share your findings with staff and providers
Inform provider not everything gets paid
Medical Billing Process Denial Management
10
Medical Billing Process Denial Management
Medical Billing Process Cost For NOT Working Denials
90 CLAIMS PER DAY AT $90 PER CLAIM = $8100
IF 10 DENIED = $810 IN DENIAL PER DAY
IF ONLY 1 IN 10 DENIALS ARE APPEALED IT =$72900 PER DAY
52 WEEKS X 5 DAYS ndash 20 DAY (VACATIONS AND HOLIDAYS) = 240 WORKING DAYS
240 DAYS X $72900 = $174960 LOST PER YEAR
Medical Billing Process Useful Reports
Practice Analysis
Insurance Aging (90 120 151)
Secondary Aging (medigap claims)
Procedure Analysis
Diagnosis Analysis
Patient Aging
Denial Report
Surgery Report
11
Timely Filing Guidelines Carrier Time Frame
United Health Care 90 Days from date of Service
Oxford 90 Days from Date of Service
Aetna 180 Days from Date of Service
Cigna 90 Days from Date of Service
Cigna Great West 15 months
Medicare 12 months (Calendar )
This will differ if the provider is NON PAR For example Cigna is 180 Days
Proof of Timely Filing Most carriers want your EDI reports to show claims
accepted and acknowledged by Payor
Some Carriers REQUIRE you use their forms to appeal
Itrsquos not enough to have an acceptance from your clearinghouse They want acknowledgement that THEY received it
If you mailed your claims then you should have mailed certified with return receipt
Corrective Claims Guidelines Carrier Time Frame
United Health Care 60 Days from date of remit
Oxford 60 Days from date of remit
Aetna 12 Months from date of remit
Cigna 180 Days from date of remit
Some may require that you use THEIR forms others may allow you to simply write a request Forms may vary depending on state where provider is located Should ALWAYS BE SENT CERTIFIED WITH RETURN RECEIPT Keep a file andor log so you can track
12
Reasons Patients DONrsquoT Pay Job loss reduced income
Emergency situations
Loss of insurance coverage
Hardship
Not understanding insurance plans
Wasnrsquot aware they owed
Killing The Awkward Silence Of Collecting Money
Kill it with kindness
Keep it simple keep it professional be assertive
Offer multiple payment options
Different Type of Collections Letters Financial Policy
Funds Were Paid To Patient
Past Due Notices (30 60 90)
Offering Different Payment Methods
No Payment Received By Carriers
Pre-Existing Clause
Insurance Verification Letter
Financial Hardship
13
The Cost To Collect A Copay Copay
Amount CashCheck
at time of service
Credit Card payment in
office
Billing the patient
Billing the patient TWICE
$2000 $0 ($2000) $96 ($1904) $300 (1700) $600 (1400)
Patient has been billed three times and NEVER Pays
- $2900
Different Payment Options Debit Cards
Credit Cards
Online AUTOMATIC withdrawals from checking or savings
Check
Cash
Via your website
Paypal
Online Bill Payment Merchant accounts now offer ways to pay by credit
card via the internet where the patient feels comfortable putting in their own information For example we use Netdeposit Set up direct payment out of their check savings and or credit card Taken out automatically monthly or bimonthly
( check payment online)
14
The Benefits Of Online Bill Payments Automatic debit from any account type
Recurring payment schedules
View payment history
View future payments
Archived payment receipts
Receipts emailed to both patient and practice
Payment scheduled is also emailed to patient and practice
Online Payment History
GENERAL TRANSACTION VIEW BEGINNING 02042013
Month Checks Ck Amt Credit Cards Credit Amt Total Rev
Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677
Skip Tracing Methods What is Skip Trace
Skip Trace Identifiers
Patientrsquos EXACT full name
Date of Birth or Age
Social Security Numbers
Previous Address ndash Last Known
Driverrsquos License Number
Insurance Policy Numbers
15
Skip Tracing Methods- Let Your Monthly
Statements Do the work For YOU
Use your Postal Service - Ancillary Service Endorsements
Return Service Requested
Temp-Return Service Requested
Address Service Requested
Change Service Requested
NCOA-Link services
Letting Monthly Statements Do The Work For YOU
NCOA-LINK
16
Internet Skip Trace Many different websites to assist you
www411com
wwwuspscom
wwwgooglecom
Other people search sites
The cost vary from $100 to $35000
Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People
Name Age Previous
Cities DOB Phone Address Avg Income
Avg Home
Value Relatives
1
Yvonne D
Dailey
38 Bradenton FL
Oneco FL
Randall T
Dailey (40)
Connie Y
Dailey (70)
Thomas M
Dailey (70)
Constance Y
Dailey (70)
William F
Dailey (36)
2
Yvonne D
Dailey
41
Long Branch
NJ
Albuquerque
NM
Toms River
NJ
Delroy A
Dailey (40)
Bill Dailey
Mr Dailey
3 Yvonne D
Dailey
52
Austin TX
Claremore
OK
Spicewood
TX
Camille
Yvonne
Dailey (52)
Jon Dailey
Perform written as well as oral communications Use the collection letters
Call the patient if over 60 days
Offer a payment plan and stick to it
Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place
17
Small Claims vs Collection Agency Know when to cut your losses and at what price
Regardless of route you use you will need to prove your collection efforts
Small claims will cost you the cost of court plus the attorney fee ndash Patients fear court
Collection Agency ndash negotiate your fees (28 to 45 of collections)
Questions Thank you for attending
How to contact us infodaileybillingcom
Yvonne Dailey CPCCPCI ydaileydaileybillingcom
Website wwwdaileybillingcom
Resources United States Postal Service wwwuspscom
Netdeposit ndash wwwnetdepositcom Online Merchant Vendor
Useful websites www411com wwwyellowbookcom
Example letters Yvonne Dailey-Dailey Billing Services wwwdaileybillingcom
6
Medical Billing Process Charge Entry
Enter all charges
Review BEFORE submission
Based on the providerrsquos documentation
Review for lost revenue (administration supplies etc)
Samples of things to review
NPI referring provider information on set date DOB DOS
Know payer policies for what is billed
Know carrier timely guidelines
Are any modifiers needed
Medical Billing Process Charge Entry
Letrsquos review the sample charge ticket
How many billable charges are there
Is there anything missing
Will it require a modifier
Do you need a referring andor ordering provider
Does it make a difference if this is a Medicare pt or a Commercial pt Why or why not
Now letrsquos look at the 1500 for this claim
Medical Billing Process Charge Entry
7
Medical Billing Process Charge Entry
Medical Billing Process Claim Submission
Review and document your claim submissions
If your clearinghouse allows corrections on the site be sure to correct on your end also
Review your EDI reports daily
Know what reports are needed for appeals andor fighting your timely filing
Know your claim submission file (837 835 997 etc)
Medical Billing Process Payment Posting
All payments must be posted ndash EVEN your ZERO dollar EOBs and even if you are going to work the denialrejection post it
Know your denial codes such as CO50 CO45 PR204 etc
Use notes in your system ndash important
Document all communication with carriers ndash date time and person you spoke to
8
Medical Billing Process Payment Posting
Letrsquos review the following example
Par Dr Amt Billed
Pd at TOS
Carrier payment
Write off amount
Amt to bill pt
Difference
$200 $10 $100
Non Par
$200 $10 $100
Medical Billing Process AR Follow UP
Follow Up - Most important to manage the AR
Must be able to research and know where to search
Insurance Aging
Patient Aging
Work weekly monthly quarterly yearly
Pick up the phone ndash it still works
Document your follow up attempts notes letters phone calls etc
Medical Billing Process Denial Management
In many cases practice denials represent internal errors
Loss of revenue or delayed revenue
Track denials
Train staff on payer policies coding billing (your findings)
Monitor
Make staff members accountable
9
Medical Billing Process Denial Management
Know the difference between a denial and rejection
Letrsquos review denial code CO50
PR27
Which is a rejection and which is a denial
Understand how to read your EOBs
Just because the EOB states to write it off doesnrsquot always mean you write it off
APPEAL APPEAL APPEAL
Medical Billing Process Denial Management
Clearinghouse Dashboards
Gives complete summary (accepted denials)
Overview of your top rejections
Use as training tool
Share your findings with staff and providers
Inform provider not everything gets paid
Medical Billing Process Denial Management
10
Medical Billing Process Denial Management
Medical Billing Process Cost For NOT Working Denials
90 CLAIMS PER DAY AT $90 PER CLAIM = $8100
IF 10 DENIED = $810 IN DENIAL PER DAY
IF ONLY 1 IN 10 DENIALS ARE APPEALED IT =$72900 PER DAY
52 WEEKS X 5 DAYS ndash 20 DAY (VACATIONS AND HOLIDAYS) = 240 WORKING DAYS
240 DAYS X $72900 = $174960 LOST PER YEAR
Medical Billing Process Useful Reports
Practice Analysis
Insurance Aging (90 120 151)
Secondary Aging (medigap claims)
Procedure Analysis
Diagnosis Analysis
Patient Aging
Denial Report
Surgery Report
11
Timely Filing Guidelines Carrier Time Frame
United Health Care 90 Days from date of Service
Oxford 90 Days from Date of Service
Aetna 180 Days from Date of Service
Cigna 90 Days from Date of Service
Cigna Great West 15 months
Medicare 12 months (Calendar )
This will differ if the provider is NON PAR For example Cigna is 180 Days
Proof of Timely Filing Most carriers want your EDI reports to show claims
accepted and acknowledged by Payor
Some Carriers REQUIRE you use their forms to appeal
Itrsquos not enough to have an acceptance from your clearinghouse They want acknowledgement that THEY received it
If you mailed your claims then you should have mailed certified with return receipt
Corrective Claims Guidelines Carrier Time Frame
United Health Care 60 Days from date of remit
Oxford 60 Days from date of remit
Aetna 12 Months from date of remit
Cigna 180 Days from date of remit
Some may require that you use THEIR forms others may allow you to simply write a request Forms may vary depending on state where provider is located Should ALWAYS BE SENT CERTIFIED WITH RETURN RECEIPT Keep a file andor log so you can track
12
Reasons Patients DONrsquoT Pay Job loss reduced income
Emergency situations
Loss of insurance coverage
Hardship
Not understanding insurance plans
Wasnrsquot aware they owed
Killing The Awkward Silence Of Collecting Money
Kill it with kindness
Keep it simple keep it professional be assertive
Offer multiple payment options
Different Type of Collections Letters Financial Policy
Funds Were Paid To Patient
Past Due Notices (30 60 90)
Offering Different Payment Methods
No Payment Received By Carriers
Pre-Existing Clause
Insurance Verification Letter
Financial Hardship
13
The Cost To Collect A Copay Copay
Amount CashCheck
at time of service
Credit Card payment in
office
Billing the patient
Billing the patient TWICE
$2000 $0 ($2000) $96 ($1904) $300 (1700) $600 (1400)
Patient has been billed three times and NEVER Pays
- $2900
Different Payment Options Debit Cards
Credit Cards
Online AUTOMATIC withdrawals from checking or savings
Check
Cash
Via your website
Paypal
Online Bill Payment Merchant accounts now offer ways to pay by credit
card via the internet where the patient feels comfortable putting in their own information For example we use Netdeposit Set up direct payment out of their check savings and or credit card Taken out automatically monthly or bimonthly
( check payment online)
14
The Benefits Of Online Bill Payments Automatic debit from any account type
Recurring payment schedules
View payment history
View future payments
Archived payment receipts
Receipts emailed to both patient and practice
Payment scheduled is also emailed to patient and practice
Online Payment History
GENERAL TRANSACTION VIEW BEGINNING 02042013
Month Checks Ck Amt Credit Cards Credit Amt Total Rev
Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677
Skip Tracing Methods What is Skip Trace
Skip Trace Identifiers
Patientrsquos EXACT full name
Date of Birth or Age
Social Security Numbers
Previous Address ndash Last Known
Driverrsquos License Number
Insurance Policy Numbers
15
Skip Tracing Methods- Let Your Monthly
Statements Do the work For YOU
Use your Postal Service - Ancillary Service Endorsements
Return Service Requested
Temp-Return Service Requested
Address Service Requested
Change Service Requested
NCOA-Link services
Letting Monthly Statements Do The Work For YOU
NCOA-LINK
16
Internet Skip Trace Many different websites to assist you
www411com
wwwuspscom
wwwgooglecom
Other people search sites
The cost vary from $100 to $35000
Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People
Name Age Previous
Cities DOB Phone Address Avg Income
Avg Home
Value Relatives
1
Yvonne D
Dailey
38 Bradenton FL
Oneco FL
Randall T
Dailey (40)
Connie Y
Dailey (70)
Thomas M
Dailey (70)
Constance Y
Dailey (70)
William F
Dailey (36)
2
Yvonne D
Dailey
41
Long Branch
NJ
Albuquerque
NM
Toms River
NJ
Delroy A
Dailey (40)
Bill Dailey
Mr Dailey
3 Yvonne D
Dailey
52
Austin TX
Claremore
OK
Spicewood
TX
Camille
Yvonne
Dailey (52)
Jon Dailey
Perform written as well as oral communications Use the collection letters
Call the patient if over 60 days
Offer a payment plan and stick to it
Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place
17
Small Claims vs Collection Agency Know when to cut your losses and at what price
Regardless of route you use you will need to prove your collection efforts
Small claims will cost you the cost of court plus the attorney fee ndash Patients fear court
Collection Agency ndash negotiate your fees (28 to 45 of collections)
Questions Thank you for attending
How to contact us infodaileybillingcom
Yvonne Dailey CPCCPCI ydaileydaileybillingcom
Website wwwdaileybillingcom
Resources United States Postal Service wwwuspscom
Netdeposit ndash wwwnetdepositcom Online Merchant Vendor
Useful websites www411com wwwyellowbookcom
Example letters Yvonne Dailey-Dailey Billing Services wwwdaileybillingcom
7
Medical Billing Process Charge Entry
Medical Billing Process Claim Submission
Review and document your claim submissions
If your clearinghouse allows corrections on the site be sure to correct on your end also
Review your EDI reports daily
Know what reports are needed for appeals andor fighting your timely filing
Know your claim submission file (837 835 997 etc)
Medical Billing Process Payment Posting
All payments must be posted ndash EVEN your ZERO dollar EOBs and even if you are going to work the denialrejection post it
Know your denial codes such as CO50 CO45 PR204 etc
Use notes in your system ndash important
Document all communication with carriers ndash date time and person you spoke to
8
Medical Billing Process Payment Posting
Letrsquos review the following example
Par Dr Amt Billed
Pd at TOS
Carrier payment
Write off amount
Amt to bill pt
Difference
$200 $10 $100
Non Par
$200 $10 $100
Medical Billing Process AR Follow UP
Follow Up - Most important to manage the AR
Must be able to research and know where to search
Insurance Aging
Patient Aging
Work weekly monthly quarterly yearly
Pick up the phone ndash it still works
Document your follow up attempts notes letters phone calls etc
Medical Billing Process Denial Management
In many cases practice denials represent internal errors
Loss of revenue or delayed revenue
Track denials
Train staff on payer policies coding billing (your findings)
Monitor
Make staff members accountable
9
Medical Billing Process Denial Management
Know the difference between a denial and rejection
Letrsquos review denial code CO50
PR27
Which is a rejection and which is a denial
Understand how to read your EOBs
Just because the EOB states to write it off doesnrsquot always mean you write it off
APPEAL APPEAL APPEAL
Medical Billing Process Denial Management
Clearinghouse Dashboards
Gives complete summary (accepted denials)
Overview of your top rejections
Use as training tool
Share your findings with staff and providers
Inform provider not everything gets paid
Medical Billing Process Denial Management
10
Medical Billing Process Denial Management
Medical Billing Process Cost For NOT Working Denials
90 CLAIMS PER DAY AT $90 PER CLAIM = $8100
IF 10 DENIED = $810 IN DENIAL PER DAY
IF ONLY 1 IN 10 DENIALS ARE APPEALED IT =$72900 PER DAY
52 WEEKS X 5 DAYS ndash 20 DAY (VACATIONS AND HOLIDAYS) = 240 WORKING DAYS
240 DAYS X $72900 = $174960 LOST PER YEAR
Medical Billing Process Useful Reports
Practice Analysis
Insurance Aging (90 120 151)
Secondary Aging (medigap claims)
Procedure Analysis
Diagnosis Analysis
Patient Aging
Denial Report
Surgery Report
11
Timely Filing Guidelines Carrier Time Frame
United Health Care 90 Days from date of Service
Oxford 90 Days from Date of Service
Aetna 180 Days from Date of Service
Cigna 90 Days from Date of Service
Cigna Great West 15 months
Medicare 12 months (Calendar )
This will differ if the provider is NON PAR For example Cigna is 180 Days
Proof of Timely Filing Most carriers want your EDI reports to show claims
accepted and acknowledged by Payor
Some Carriers REQUIRE you use their forms to appeal
Itrsquos not enough to have an acceptance from your clearinghouse They want acknowledgement that THEY received it
If you mailed your claims then you should have mailed certified with return receipt
Corrective Claims Guidelines Carrier Time Frame
United Health Care 60 Days from date of remit
Oxford 60 Days from date of remit
Aetna 12 Months from date of remit
Cigna 180 Days from date of remit
Some may require that you use THEIR forms others may allow you to simply write a request Forms may vary depending on state where provider is located Should ALWAYS BE SENT CERTIFIED WITH RETURN RECEIPT Keep a file andor log so you can track
12
Reasons Patients DONrsquoT Pay Job loss reduced income
Emergency situations
Loss of insurance coverage
Hardship
Not understanding insurance plans
Wasnrsquot aware they owed
Killing The Awkward Silence Of Collecting Money
Kill it with kindness
Keep it simple keep it professional be assertive
Offer multiple payment options
Different Type of Collections Letters Financial Policy
Funds Were Paid To Patient
Past Due Notices (30 60 90)
Offering Different Payment Methods
No Payment Received By Carriers
Pre-Existing Clause
Insurance Verification Letter
Financial Hardship
13
The Cost To Collect A Copay Copay
Amount CashCheck
at time of service
Credit Card payment in
office
Billing the patient
Billing the patient TWICE
$2000 $0 ($2000) $96 ($1904) $300 (1700) $600 (1400)
Patient has been billed three times and NEVER Pays
- $2900
Different Payment Options Debit Cards
Credit Cards
Online AUTOMATIC withdrawals from checking or savings
Check
Cash
Via your website
Paypal
Online Bill Payment Merchant accounts now offer ways to pay by credit
card via the internet where the patient feels comfortable putting in their own information For example we use Netdeposit Set up direct payment out of their check savings and or credit card Taken out automatically monthly or bimonthly
( check payment online)
14
The Benefits Of Online Bill Payments Automatic debit from any account type
Recurring payment schedules
View payment history
View future payments
Archived payment receipts
Receipts emailed to both patient and practice
Payment scheduled is also emailed to patient and practice
Online Payment History
GENERAL TRANSACTION VIEW BEGINNING 02042013
Month Checks Ck Amt Credit Cards Credit Amt Total Rev
Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677
Skip Tracing Methods What is Skip Trace
Skip Trace Identifiers
Patientrsquos EXACT full name
Date of Birth or Age
Social Security Numbers
Previous Address ndash Last Known
Driverrsquos License Number
Insurance Policy Numbers
15
Skip Tracing Methods- Let Your Monthly
Statements Do the work For YOU
Use your Postal Service - Ancillary Service Endorsements
Return Service Requested
Temp-Return Service Requested
Address Service Requested
Change Service Requested
NCOA-Link services
Letting Monthly Statements Do The Work For YOU
NCOA-LINK
16
Internet Skip Trace Many different websites to assist you
www411com
wwwuspscom
wwwgooglecom
Other people search sites
The cost vary from $100 to $35000
Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People
Name Age Previous
Cities DOB Phone Address Avg Income
Avg Home
Value Relatives
1
Yvonne D
Dailey
38 Bradenton FL
Oneco FL
Randall T
Dailey (40)
Connie Y
Dailey (70)
Thomas M
Dailey (70)
Constance Y
Dailey (70)
William F
Dailey (36)
2
Yvonne D
Dailey
41
Long Branch
NJ
Albuquerque
NM
Toms River
NJ
Delroy A
Dailey (40)
Bill Dailey
Mr Dailey
3 Yvonne D
Dailey
52
Austin TX
Claremore
OK
Spicewood
TX
Camille
Yvonne
Dailey (52)
Jon Dailey
Perform written as well as oral communications Use the collection letters
Call the patient if over 60 days
Offer a payment plan and stick to it
Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place
17
Small Claims vs Collection Agency Know when to cut your losses and at what price
Regardless of route you use you will need to prove your collection efforts
Small claims will cost you the cost of court plus the attorney fee ndash Patients fear court
Collection Agency ndash negotiate your fees (28 to 45 of collections)
Questions Thank you for attending
How to contact us infodaileybillingcom
Yvonne Dailey CPCCPCI ydaileydaileybillingcom
Website wwwdaileybillingcom
Resources United States Postal Service wwwuspscom
Netdeposit ndash wwwnetdepositcom Online Merchant Vendor
Useful websites www411com wwwyellowbookcom
Example letters Yvonne Dailey-Dailey Billing Services wwwdaileybillingcom
8
Medical Billing Process Payment Posting
Letrsquos review the following example
Par Dr Amt Billed
Pd at TOS
Carrier payment
Write off amount
Amt to bill pt
Difference
$200 $10 $100
Non Par
$200 $10 $100
Medical Billing Process AR Follow UP
Follow Up - Most important to manage the AR
Must be able to research and know where to search
Insurance Aging
Patient Aging
Work weekly monthly quarterly yearly
Pick up the phone ndash it still works
Document your follow up attempts notes letters phone calls etc
Medical Billing Process Denial Management
In many cases practice denials represent internal errors
Loss of revenue or delayed revenue
Track denials
Train staff on payer policies coding billing (your findings)
Monitor
Make staff members accountable
9
Medical Billing Process Denial Management
Know the difference between a denial and rejection
Letrsquos review denial code CO50
PR27
Which is a rejection and which is a denial
Understand how to read your EOBs
Just because the EOB states to write it off doesnrsquot always mean you write it off
APPEAL APPEAL APPEAL
Medical Billing Process Denial Management
Clearinghouse Dashboards
Gives complete summary (accepted denials)
Overview of your top rejections
Use as training tool
Share your findings with staff and providers
Inform provider not everything gets paid
Medical Billing Process Denial Management
10
Medical Billing Process Denial Management
Medical Billing Process Cost For NOT Working Denials
90 CLAIMS PER DAY AT $90 PER CLAIM = $8100
IF 10 DENIED = $810 IN DENIAL PER DAY
IF ONLY 1 IN 10 DENIALS ARE APPEALED IT =$72900 PER DAY
52 WEEKS X 5 DAYS ndash 20 DAY (VACATIONS AND HOLIDAYS) = 240 WORKING DAYS
240 DAYS X $72900 = $174960 LOST PER YEAR
Medical Billing Process Useful Reports
Practice Analysis
Insurance Aging (90 120 151)
Secondary Aging (medigap claims)
Procedure Analysis
Diagnosis Analysis
Patient Aging
Denial Report
Surgery Report
11
Timely Filing Guidelines Carrier Time Frame
United Health Care 90 Days from date of Service
Oxford 90 Days from Date of Service
Aetna 180 Days from Date of Service
Cigna 90 Days from Date of Service
Cigna Great West 15 months
Medicare 12 months (Calendar )
This will differ if the provider is NON PAR For example Cigna is 180 Days
Proof of Timely Filing Most carriers want your EDI reports to show claims
accepted and acknowledged by Payor
Some Carriers REQUIRE you use their forms to appeal
Itrsquos not enough to have an acceptance from your clearinghouse They want acknowledgement that THEY received it
If you mailed your claims then you should have mailed certified with return receipt
Corrective Claims Guidelines Carrier Time Frame
United Health Care 60 Days from date of remit
Oxford 60 Days from date of remit
Aetna 12 Months from date of remit
Cigna 180 Days from date of remit
Some may require that you use THEIR forms others may allow you to simply write a request Forms may vary depending on state where provider is located Should ALWAYS BE SENT CERTIFIED WITH RETURN RECEIPT Keep a file andor log so you can track
12
Reasons Patients DONrsquoT Pay Job loss reduced income
Emergency situations
Loss of insurance coverage
Hardship
Not understanding insurance plans
Wasnrsquot aware they owed
Killing The Awkward Silence Of Collecting Money
Kill it with kindness
Keep it simple keep it professional be assertive
Offer multiple payment options
Different Type of Collections Letters Financial Policy
Funds Were Paid To Patient
Past Due Notices (30 60 90)
Offering Different Payment Methods
No Payment Received By Carriers
Pre-Existing Clause
Insurance Verification Letter
Financial Hardship
13
The Cost To Collect A Copay Copay
Amount CashCheck
at time of service
Credit Card payment in
office
Billing the patient
Billing the patient TWICE
$2000 $0 ($2000) $96 ($1904) $300 (1700) $600 (1400)
Patient has been billed three times and NEVER Pays
- $2900
Different Payment Options Debit Cards
Credit Cards
Online AUTOMATIC withdrawals from checking or savings
Check
Cash
Via your website
Paypal
Online Bill Payment Merchant accounts now offer ways to pay by credit
card via the internet where the patient feels comfortable putting in their own information For example we use Netdeposit Set up direct payment out of their check savings and or credit card Taken out automatically monthly or bimonthly
( check payment online)
14
The Benefits Of Online Bill Payments Automatic debit from any account type
Recurring payment schedules
View payment history
View future payments
Archived payment receipts
Receipts emailed to both patient and practice
Payment scheduled is also emailed to patient and practice
Online Payment History
GENERAL TRANSACTION VIEW BEGINNING 02042013
Month Checks Ck Amt Credit Cards Credit Amt Total Rev
Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677
Skip Tracing Methods What is Skip Trace
Skip Trace Identifiers
Patientrsquos EXACT full name
Date of Birth or Age
Social Security Numbers
Previous Address ndash Last Known
Driverrsquos License Number
Insurance Policy Numbers
15
Skip Tracing Methods- Let Your Monthly
Statements Do the work For YOU
Use your Postal Service - Ancillary Service Endorsements
Return Service Requested
Temp-Return Service Requested
Address Service Requested
Change Service Requested
NCOA-Link services
Letting Monthly Statements Do The Work For YOU
NCOA-LINK
16
Internet Skip Trace Many different websites to assist you
www411com
wwwuspscom
wwwgooglecom
Other people search sites
The cost vary from $100 to $35000
Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People
Name Age Previous
Cities DOB Phone Address Avg Income
Avg Home
Value Relatives
1
Yvonne D
Dailey
38 Bradenton FL
Oneco FL
Randall T
Dailey (40)
Connie Y
Dailey (70)
Thomas M
Dailey (70)
Constance Y
Dailey (70)
William F
Dailey (36)
2
Yvonne D
Dailey
41
Long Branch
NJ
Albuquerque
NM
Toms River
NJ
Delroy A
Dailey (40)
Bill Dailey
Mr Dailey
3 Yvonne D
Dailey
52
Austin TX
Claremore
OK
Spicewood
TX
Camille
Yvonne
Dailey (52)
Jon Dailey
Perform written as well as oral communications Use the collection letters
Call the patient if over 60 days
Offer a payment plan and stick to it
Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place
17
Small Claims vs Collection Agency Know when to cut your losses and at what price
Regardless of route you use you will need to prove your collection efforts
Small claims will cost you the cost of court plus the attorney fee ndash Patients fear court
Collection Agency ndash negotiate your fees (28 to 45 of collections)
Questions Thank you for attending
How to contact us infodaileybillingcom
Yvonne Dailey CPCCPCI ydaileydaileybillingcom
Website wwwdaileybillingcom
Resources United States Postal Service wwwuspscom
Netdeposit ndash wwwnetdepositcom Online Merchant Vendor
Useful websites www411com wwwyellowbookcom
Example letters Yvonne Dailey-Dailey Billing Services wwwdaileybillingcom
9
Medical Billing Process Denial Management
Know the difference between a denial and rejection
Letrsquos review denial code CO50
PR27
Which is a rejection and which is a denial
Understand how to read your EOBs
Just because the EOB states to write it off doesnrsquot always mean you write it off
APPEAL APPEAL APPEAL
Medical Billing Process Denial Management
Clearinghouse Dashboards
Gives complete summary (accepted denials)
Overview of your top rejections
Use as training tool
Share your findings with staff and providers
Inform provider not everything gets paid
Medical Billing Process Denial Management
10
Medical Billing Process Denial Management
Medical Billing Process Cost For NOT Working Denials
90 CLAIMS PER DAY AT $90 PER CLAIM = $8100
IF 10 DENIED = $810 IN DENIAL PER DAY
IF ONLY 1 IN 10 DENIALS ARE APPEALED IT =$72900 PER DAY
52 WEEKS X 5 DAYS ndash 20 DAY (VACATIONS AND HOLIDAYS) = 240 WORKING DAYS
240 DAYS X $72900 = $174960 LOST PER YEAR
Medical Billing Process Useful Reports
Practice Analysis
Insurance Aging (90 120 151)
Secondary Aging (medigap claims)
Procedure Analysis
Diagnosis Analysis
Patient Aging
Denial Report
Surgery Report
11
Timely Filing Guidelines Carrier Time Frame
United Health Care 90 Days from date of Service
Oxford 90 Days from Date of Service
Aetna 180 Days from Date of Service
Cigna 90 Days from Date of Service
Cigna Great West 15 months
Medicare 12 months (Calendar )
This will differ if the provider is NON PAR For example Cigna is 180 Days
Proof of Timely Filing Most carriers want your EDI reports to show claims
accepted and acknowledged by Payor
Some Carriers REQUIRE you use their forms to appeal
Itrsquos not enough to have an acceptance from your clearinghouse They want acknowledgement that THEY received it
If you mailed your claims then you should have mailed certified with return receipt
Corrective Claims Guidelines Carrier Time Frame
United Health Care 60 Days from date of remit
Oxford 60 Days from date of remit
Aetna 12 Months from date of remit
Cigna 180 Days from date of remit
Some may require that you use THEIR forms others may allow you to simply write a request Forms may vary depending on state where provider is located Should ALWAYS BE SENT CERTIFIED WITH RETURN RECEIPT Keep a file andor log so you can track
12
Reasons Patients DONrsquoT Pay Job loss reduced income
Emergency situations
Loss of insurance coverage
Hardship
Not understanding insurance plans
Wasnrsquot aware they owed
Killing The Awkward Silence Of Collecting Money
Kill it with kindness
Keep it simple keep it professional be assertive
Offer multiple payment options
Different Type of Collections Letters Financial Policy
Funds Were Paid To Patient
Past Due Notices (30 60 90)
Offering Different Payment Methods
No Payment Received By Carriers
Pre-Existing Clause
Insurance Verification Letter
Financial Hardship
13
The Cost To Collect A Copay Copay
Amount CashCheck
at time of service
Credit Card payment in
office
Billing the patient
Billing the patient TWICE
$2000 $0 ($2000) $96 ($1904) $300 (1700) $600 (1400)
Patient has been billed three times and NEVER Pays
- $2900
Different Payment Options Debit Cards
Credit Cards
Online AUTOMATIC withdrawals from checking or savings
Check
Cash
Via your website
Paypal
Online Bill Payment Merchant accounts now offer ways to pay by credit
card via the internet where the patient feels comfortable putting in their own information For example we use Netdeposit Set up direct payment out of their check savings and or credit card Taken out automatically monthly or bimonthly
( check payment online)
14
The Benefits Of Online Bill Payments Automatic debit from any account type
Recurring payment schedules
View payment history
View future payments
Archived payment receipts
Receipts emailed to both patient and practice
Payment scheduled is also emailed to patient and practice
Online Payment History
GENERAL TRANSACTION VIEW BEGINNING 02042013
Month Checks Ck Amt Credit Cards Credit Amt Total Rev
Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677
Skip Tracing Methods What is Skip Trace
Skip Trace Identifiers
Patientrsquos EXACT full name
Date of Birth or Age
Social Security Numbers
Previous Address ndash Last Known
Driverrsquos License Number
Insurance Policy Numbers
15
Skip Tracing Methods- Let Your Monthly
Statements Do the work For YOU
Use your Postal Service - Ancillary Service Endorsements
Return Service Requested
Temp-Return Service Requested
Address Service Requested
Change Service Requested
NCOA-Link services
Letting Monthly Statements Do The Work For YOU
NCOA-LINK
16
Internet Skip Trace Many different websites to assist you
www411com
wwwuspscom
wwwgooglecom
Other people search sites
The cost vary from $100 to $35000
Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People
Name Age Previous
Cities DOB Phone Address Avg Income
Avg Home
Value Relatives
1
Yvonne D
Dailey
38 Bradenton FL
Oneco FL
Randall T
Dailey (40)
Connie Y
Dailey (70)
Thomas M
Dailey (70)
Constance Y
Dailey (70)
William F
Dailey (36)
2
Yvonne D
Dailey
41
Long Branch
NJ
Albuquerque
NM
Toms River
NJ
Delroy A
Dailey (40)
Bill Dailey
Mr Dailey
3 Yvonne D
Dailey
52
Austin TX
Claremore
OK
Spicewood
TX
Camille
Yvonne
Dailey (52)
Jon Dailey
Perform written as well as oral communications Use the collection letters
Call the patient if over 60 days
Offer a payment plan and stick to it
Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place
17
Small Claims vs Collection Agency Know when to cut your losses and at what price
Regardless of route you use you will need to prove your collection efforts
Small claims will cost you the cost of court plus the attorney fee ndash Patients fear court
Collection Agency ndash negotiate your fees (28 to 45 of collections)
Questions Thank you for attending
How to contact us infodaileybillingcom
Yvonne Dailey CPCCPCI ydaileydaileybillingcom
Website wwwdaileybillingcom
Resources United States Postal Service wwwuspscom
Netdeposit ndash wwwnetdepositcom Online Merchant Vendor
Useful websites www411com wwwyellowbookcom
Example letters Yvonne Dailey-Dailey Billing Services wwwdaileybillingcom
10
Medical Billing Process Denial Management
Medical Billing Process Cost For NOT Working Denials
90 CLAIMS PER DAY AT $90 PER CLAIM = $8100
IF 10 DENIED = $810 IN DENIAL PER DAY
IF ONLY 1 IN 10 DENIALS ARE APPEALED IT =$72900 PER DAY
52 WEEKS X 5 DAYS ndash 20 DAY (VACATIONS AND HOLIDAYS) = 240 WORKING DAYS
240 DAYS X $72900 = $174960 LOST PER YEAR
Medical Billing Process Useful Reports
Practice Analysis
Insurance Aging (90 120 151)
Secondary Aging (medigap claims)
Procedure Analysis
Diagnosis Analysis
Patient Aging
Denial Report
Surgery Report
11
Timely Filing Guidelines Carrier Time Frame
United Health Care 90 Days from date of Service
Oxford 90 Days from Date of Service
Aetna 180 Days from Date of Service
Cigna 90 Days from Date of Service
Cigna Great West 15 months
Medicare 12 months (Calendar )
This will differ if the provider is NON PAR For example Cigna is 180 Days
Proof of Timely Filing Most carriers want your EDI reports to show claims
accepted and acknowledged by Payor
Some Carriers REQUIRE you use their forms to appeal
Itrsquos not enough to have an acceptance from your clearinghouse They want acknowledgement that THEY received it
If you mailed your claims then you should have mailed certified with return receipt
Corrective Claims Guidelines Carrier Time Frame
United Health Care 60 Days from date of remit
Oxford 60 Days from date of remit
Aetna 12 Months from date of remit
Cigna 180 Days from date of remit
Some may require that you use THEIR forms others may allow you to simply write a request Forms may vary depending on state where provider is located Should ALWAYS BE SENT CERTIFIED WITH RETURN RECEIPT Keep a file andor log so you can track
12
Reasons Patients DONrsquoT Pay Job loss reduced income
Emergency situations
Loss of insurance coverage
Hardship
Not understanding insurance plans
Wasnrsquot aware they owed
Killing The Awkward Silence Of Collecting Money
Kill it with kindness
Keep it simple keep it professional be assertive
Offer multiple payment options
Different Type of Collections Letters Financial Policy
Funds Were Paid To Patient
Past Due Notices (30 60 90)
Offering Different Payment Methods
No Payment Received By Carriers
Pre-Existing Clause
Insurance Verification Letter
Financial Hardship
13
The Cost To Collect A Copay Copay
Amount CashCheck
at time of service
Credit Card payment in
office
Billing the patient
Billing the patient TWICE
$2000 $0 ($2000) $96 ($1904) $300 (1700) $600 (1400)
Patient has been billed three times and NEVER Pays
- $2900
Different Payment Options Debit Cards
Credit Cards
Online AUTOMATIC withdrawals from checking or savings
Check
Cash
Via your website
Paypal
Online Bill Payment Merchant accounts now offer ways to pay by credit
card via the internet where the patient feels comfortable putting in their own information For example we use Netdeposit Set up direct payment out of their check savings and or credit card Taken out automatically monthly or bimonthly
( check payment online)
14
The Benefits Of Online Bill Payments Automatic debit from any account type
Recurring payment schedules
View payment history
View future payments
Archived payment receipts
Receipts emailed to both patient and practice
Payment scheduled is also emailed to patient and practice
Online Payment History
GENERAL TRANSACTION VIEW BEGINNING 02042013
Month Checks Ck Amt Credit Cards Credit Amt Total Rev
Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677
Skip Tracing Methods What is Skip Trace
Skip Trace Identifiers
Patientrsquos EXACT full name
Date of Birth or Age
Social Security Numbers
Previous Address ndash Last Known
Driverrsquos License Number
Insurance Policy Numbers
15
Skip Tracing Methods- Let Your Monthly
Statements Do the work For YOU
Use your Postal Service - Ancillary Service Endorsements
Return Service Requested
Temp-Return Service Requested
Address Service Requested
Change Service Requested
NCOA-Link services
Letting Monthly Statements Do The Work For YOU
NCOA-LINK
16
Internet Skip Trace Many different websites to assist you
www411com
wwwuspscom
wwwgooglecom
Other people search sites
The cost vary from $100 to $35000
Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People
Name Age Previous
Cities DOB Phone Address Avg Income
Avg Home
Value Relatives
1
Yvonne D
Dailey
38 Bradenton FL
Oneco FL
Randall T
Dailey (40)
Connie Y
Dailey (70)
Thomas M
Dailey (70)
Constance Y
Dailey (70)
William F
Dailey (36)
2
Yvonne D
Dailey
41
Long Branch
NJ
Albuquerque
NM
Toms River
NJ
Delroy A
Dailey (40)
Bill Dailey
Mr Dailey
3 Yvonne D
Dailey
52
Austin TX
Claremore
OK
Spicewood
TX
Camille
Yvonne
Dailey (52)
Jon Dailey
Perform written as well as oral communications Use the collection letters
Call the patient if over 60 days
Offer a payment plan and stick to it
Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place
17
Small Claims vs Collection Agency Know when to cut your losses and at what price
Regardless of route you use you will need to prove your collection efforts
Small claims will cost you the cost of court plus the attorney fee ndash Patients fear court
Collection Agency ndash negotiate your fees (28 to 45 of collections)
Questions Thank you for attending
How to contact us infodaileybillingcom
Yvonne Dailey CPCCPCI ydaileydaileybillingcom
Website wwwdaileybillingcom
Resources United States Postal Service wwwuspscom
Netdeposit ndash wwwnetdepositcom Online Merchant Vendor
Useful websites www411com wwwyellowbookcom
Example letters Yvonne Dailey-Dailey Billing Services wwwdaileybillingcom
11
Timely Filing Guidelines Carrier Time Frame
United Health Care 90 Days from date of Service
Oxford 90 Days from Date of Service
Aetna 180 Days from Date of Service
Cigna 90 Days from Date of Service
Cigna Great West 15 months
Medicare 12 months (Calendar )
This will differ if the provider is NON PAR For example Cigna is 180 Days
Proof of Timely Filing Most carriers want your EDI reports to show claims
accepted and acknowledged by Payor
Some Carriers REQUIRE you use their forms to appeal
Itrsquos not enough to have an acceptance from your clearinghouse They want acknowledgement that THEY received it
If you mailed your claims then you should have mailed certified with return receipt
Corrective Claims Guidelines Carrier Time Frame
United Health Care 60 Days from date of remit
Oxford 60 Days from date of remit
Aetna 12 Months from date of remit
Cigna 180 Days from date of remit
Some may require that you use THEIR forms others may allow you to simply write a request Forms may vary depending on state where provider is located Should ALWAYS BE SENT CERTIFIED WITH RETURN RECEIPT Keep a file andor log so you can track
12
Reasons Patients DONrsquoT Pay Job loss reduced income
Emergency situations
Loss of insurance coverage
Hardship
Not understanding insurance plans
Wasnrsquot aware they owed
Killing The Awkward Silence Of Collecting Money
Kill it with kindness
Keep it simple keep it professional be assertive
Offer multiple payment options
Different Type of Collections Letters Financial Policy
Funds Were Paid To Patient
Past Due Notices (30 60 90)
Offering Different Payment Methods
No Payment Received By Carriers
Pre-Existing Clause
Insurance Verification Letter
Financial Hardship
13
The Cost To Collect A Copay Copay
Amount CashCheck
at time of service
Credit Card payment in
office
Billing the patient
Billing the patient TWICE
$2000 $0 ($2000) $96 ($1904) $300 (1700) $600 (1400)
Patient has been billed three times and NEVER Pays
- $2900
Different Payment Options Debit Cards
Credit Cards
Online AUTOMATIC withdrawals from checking or savings
Check
Cash
Via your website
Paypal
Online Bill Payment Merchant accounts now offer ways to pay by credit
card via the internet where the patient feels comfortable putting in their own information For example we use Netdeposit Set up direct payment out of their check savings and or credit card Taken out automatically monthly or bimonthly
( check payment online)
14
The Benefits Of Online Bill Payments Automatic debit from any account type
Recurring payment schedules
View payment history
View future payments
Archived payment receipts
Receipts emailed to both patient and practice
Payment scheduled is also emailed to patient and practice
Online Payment History
GENERAL TRANSACTION VIEW BEGINNING 02042013
Month Checks Ck Amt Credit Cards Credit Amt Total Rev
Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677
Skip Tracing Methods What is Skip Trace
Skip Trace Identifiers
Patientrsquos EXACT full name
Date of Birth or Age
Social Security Numbers
Previous Address ndash Last Known
Driverrsquos License Number
Insurance Policy Numbers
15
Skip Tracing Methods- Let Your Monthly
Statements Do the work For YOU
Use your Postal Service - Ancillary Service Endorsements
Return Service Requested
Temp-Return Service Requested
Address Service Requested
Change Service Requested
NCOA-Link services
Letting Monthly Statements Do The Work For YOU
NCOA-LINK
16
Internet Skip Trace Many different websites to assist you
www411com
wwwuspscom
wwwgooglecom
Other people search sites
The cost vary from $100 to $35000
Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People
Name Age Previous
Cities DOB Phone Address Avg Income
Avg Home
Value Relatives
1
Yvonne D
Dailey
38 Bradenton FL
Oneco FL
Randall T
Dailey (40)
Connie Y
Dailey (70)
Thomas M
Dailey (70)
Constance Y
Dailey (70)
William F
Dailey (36)
2
Yvonne D
Dailey
41
Long Branch
NJ
Albuquerque
NM
Toms River
NJ
Delroy A
Dailey (40)
Bill Dailey
Mr Dailey
3 Yvonne D
Dailey
52
Austin TX
Claremore
OK
Spicewood
TX
Camille
Yvonne
Dailey (52)
Jon Dailey
Perform written as well as oral communications Use the collection letters
Call the patient if over 60 days
Offer a payment plan and stick to it
Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place
17
Small Claims vs Collection Agency Know when to cut your losses and at what price
Regardless of route you use you will need to prove your collection efforts
Small claims will cost you the cost of court plus the attorney fee ndash Patients fear court
Collection Agency ndash negotiate your fees (28 to 45 of collections)
Questions Thank you for attending
How to contact us infodaileybillingcom
Yvonne Dailey CPCCPCI ydaileydaileybillingcom
Website wwwdaileybillingcom
Resources United States Postal Service wwwuspscom
Netdeposit ndash wwwnetdepositcom Online Merchant Vendor
Useful websites www411com wwwyellowbookcom
Example letters Yvonne Dailey-Dailey Billing Services wwwdaileybillingcom
12
Reasons Patients DONrsquoT Pay Job loss reduced income
Emergency situations
Loss of insurance coverage
Hardship
Not understanding insurance plans
Wasnrsquot aware they owed
Killing The Awkward Silence Of Collecting Money
Kill it with kindness
Keep it simple keep it professional be assertive
Offer multiple payment options
Different Type of Collections Letters Financial Policy
Funds Were Paid To Patient
Past Due Notices (30 60 90)
Offering Different Payment Methods
No Payment Received By Carriers
Pre-Existing Clause
Insurance Verification Letter
Financial Hardship
13
The Cost To Collect A Copay Copay
Amount CashCheck
at time of service
Credit Card payment in
office
Billing the patient
Billing the patient TWICE
$2000 $0 ($2000) $96 ($1904) $300 (1700) $600 (1400)
Patient has been billed three times and NEVER Pays
- $2900
Different Payment Options Debit Cards
Credit Cards
Online AUTOMATIC withdrawals from checking or savings
Check
Cash
Via your website
Paypal
Online Bill Payment Merchant accounts now offer ways to pay by credit
card via the internet where the patient feels comfortable putting in their own information For example we use Netdeposit Set up direct payment out of their check savings and or credit card Taken out automatically monthly or bimonthly
( check payment online)
14
The Benefits Of Online Bill Payments Automatic debit from any account type
Recurring payment schedules
View payment history
View future payments
Archived payment receipts
Receipts emailed to both patient and practice
Payment scheduled is also emailed to patient and practice
Online Payment History
GENERAL TRANSACTION VIEW BEGINNING 02042013
Month Checks Ck Amt Credit Cards Credit Amt Total Rev
Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677
Skip Tracing Methods What is Skip Trace
Skip Trace Identifiers
Patientrsquos EXACT full name
Date of Birth or Age
Social Security Numbers
Previous Address ndash Last Known
Driverrsquos License Number
Insurance Policy Numbers
15
Skip Tracing Methods- Let Your Monthly
Statements Do the work For YOU
Use your Postal Service - Ancillary Service Endorsements
Return Service Requested
Temp-Return Service Requested
Address Service Requested
Change Service Requested
NCOA-Link services
Letting Monthly Statements Do The Work For YOU
NCOA-LINK
16
Internet Skip Trace Many different websites to assist you
www411com
wwwuspscom
wwwgooglecom
Other people search sites
The cost vary from $100 to $35000
Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People
Name Age Previous
Cities DOB Phone Address Avg Income
Avg Home
Value Relatives
1
Yvonne D
Dailey
38 Bradenton FL
Oneco FL
Randall T
Dailey (40)
Connie Y
Dailey (70)
Thomas M
Dailey (70)
Constance Y
Dailey (70)
William F
Dailey (36)
2
Yvonne D
Dailey
41
Long Branch
NJ
Albuquerque
NM
Toms River
NJ
Delroy A
Dailey (40)
Bill Dailey
Mr Dailey
3 Yvonne D
Dailey
52
Austin TX
Claremore
OK
Spicewood
TX
Camille
Yvonne
Dailey (52)
Jon Dailey
Perform written as well as oral communications Use the collection letters
Call the patient if over 60 days
Offer a payment plan and stick to it
Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place
17
Small Claims vs Collection Agency Know when to cut your losses and at what price
Regardless of route you use you will need to prove your collection efforts
Small claims will cost you the cost of court plus the attorney fee ndash Patients fear court
Collection Agency ndash negotiate your fees (28 to 45 of collections)
Questions Thank you for attending
How to contact us infodaileybillingcom
Yvonne Dailey CPCCPCI ydaileydaileybillingcom
Website wwwdaileybillingcom
Resources United States Postal Service wwwuspscom
Netdeposit ndash wwwnetdepositcom Online Merchant Vendor
Useful websites www411com wwwyellowbookcom
Example letters Yvonne Dailey-Dailey Billing Services wwwdaileybillingcom
13
The Cost To Collect A Copay Copay
Amount CashCheck
at time of service
Credit Card payment in
office
Billing the patient
Billing the patient TWICE
$2000 $0 ($2000) $96 ($1904) $300 (1700) $600 (1400)
Patient has been billed three times and NEVER Pays
- $2900
Different Payment Options Debit Cards
Credit Cards
Online AUTOMATIC withdrawals from checking or savings
Check
Cash
Via your website
Paypal
Online Bill Payment Merchant accounts now offer ways to pay by credit
card via the internet where the patient feels comfortable putting in their own information For example we use Netdeposit Set up direct payment out of their check savings and or credit card Taken out automatically monthly or bimonthly
( check payment online)
14
The Benefits Of Online Bill Payments Automatic debit from any account type
Recurring payment schedules
View payment history
View future payments
Archived payment receipts
Receipts emailed to both patient and practice
Payment scheduled is also emailed to patient and practice
Online Payment History
GENERAL TRANSACTION VIEW BEGINNING 02042013
Month Checks Ck Amt Credit Cards Credit Amt Total Rev
Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677
Skip Tracing Methods What is Skip Trace
Skip Trace Identifiers
Patientrsquos EXACT full name
Date of Birth or Age
Social Security Numbers
Previous Address ndash Last Known
Driverrsquos License Number
Insurance Policy Numbers
15
Skip Tracing Methods- Let Your Monthly
Statements Do the work For YOU
Use your Postal Service - Ancillary Service Endorsements
Return Service Requested
Temp-Return Service Requested
Address Service Requested
Change Service Requested
NCOA-Link services
Letting Monthly Statements Do The Work For YOU
NCOA-LINK
16
Internet Skip Trace Many different websites to assist you
www411com
wwwuspscom
wwwgooglecom
Other people search sites
The cost vary from $100 to $35000
Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People
Name Age Previous
Cities DOB Phone Address Avg Income
Avg Home
Value Relatives
1
Yvonne D
Dailey
38 Bradenton FL
Oneco FL
Randall T
Dailey (40)
Connie Y
Dailey (70)
Thomas M
Dailey (70)
Constance Y
Dailey (70)
William F
Dailey (36)
2
Yvonne D
Dailey
41
Long Branch
NJ
Albuquerque
NM
Toms River
NJ
Delroy A
Dailey (40)
Bill Dailey
Mr Dailey
3 Yvonne D
Dailey
52
Austin TX
Claremore
OK
Spicewood
TX
Camille
Yvonne
Dailey (52)
Jon Dailey
Perform written as well as oral communications Use the collection letters
Call the patient if over 60 days
Offer a payment plan and stick to it
Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place
17
Small Claims vs Collection Agency Know when to cut your losses and at what price
Regardless of route you use you will need to prove your collection efforts
Small claims will cost you the cost of court plus the attorney fee ndash Patients fear court
Collection Agency ndash negotiate your fees (28 to 45 of collections)
Questions Thank you for attending
How to contact us infodaileybillingcom
Yvonne Dailey CPCCPCI ydaileydaileybillingcom
Website wwwdaileybillingcom
Resources United States Postal Service wwwuspscom
Netdeposit ndash wwwnetdepositcom Online Merchant Vendor
Useful websites www411com wwwyellowbookcom
Example letters Yvonne Dailey-Dailey Billing Services wwwdaileybillingcom
14
The Benefits Of Online Bill Payments Automatic debit from any account type
Recurring payment schedules
View payment history
View future payments
Archived payment receipts
Receipts emailed to both patient and practice
Payment scheduled is also emailed to patient and practice
Online Payment History
GENERAL TRANSACTION VIEW BEGINNING 02042013
Month Checks Ck Amt Credit Cards Credit Amt Total Rev
Feb 2013 1 $18770 7 $35039 $53809 Mar 2013 1 $18770 3 $15789 $34559 Apr 2013 1 $18770 2 $10000 $28770 May 2013 1 $18770 0 $000 $18770 Jun 2013 1 $18769 0 $000 $18769 Jul 2013 0 $000 0 $000 $000 Aug 2013 0 $000 0 $000 $000 Sep 2013 0 $000 0 $000 $000 Oct 2013 0 $000 0 $000 $000 Nov 2013 0 $000 0 $000 $000 Dec 2013 0 $000 0 $000 $000 Jan 2014 0 $000 0 $000 $000 Feb 2014 0 $000 0 $000 $000 TOTALS 5 $93849 12 $60828 $154677
Skip Tracing Methods What is Skip Trace
Skip Trace Identifiers
Patientrsquos EXACT full name
Date of Birth or Age
Social Security Numbers
Previous Address ndash Last Known
Driverrsquos License Number
Insurance Policy Numbers
15
Skip Tracing Methods- Let Your Monthly
Statements Do the work For YOU
Use your Postal Service - Ancillary Service Endorsements
Return Service Requested
Temp-Return Service Requested
Address Service Requested
Change Service Requested
NCOA-Link services
Letting Monthly Statements Do The Work For YOU
NCOA-LINK
16
Internet Skip Trace Many different websites to assist you
www411com
wwwuspscom
wwwgooglecom
Other people search sites
The cost vary from $100 to $35000
Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People
Name Age Previous
Cities DOB Phone Address Avg Income
Avg Home
Value Relatives
1
Yvonne D
Dailey
38 Bradenton FL
Oneco FL
Randall T
Dailey (40)
Connie Y
Dailey (70)
Thomas M
Dailey (70)
Constance Y
Dailey (70)
William F
Dailey (36)
2
Yvonne D
Dailey
41
Long Branch
NJ
Albuquerque
NM
Toms River
NJ
Delroy A
Dailey (40)
Bill Dailey
Mr Dailey
3 Yvonne D
Dailey
52
Austin TX
Claremore
OK
Spicewood
TX
Camille
Yvonne
Dailey (52)
Jon Dailey
Perform written as well as oral communications Use the collection letters
Call the patient if over 60 days
Offer a payment plan and stick to it
Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place
17
Small Claims vs Collection Agency Know when to cut your losses and at what price
Regardless of route you use you will need to prove your collection efforts
Small claims will cost you the cost of court plus the attorney fee ndash Patients fear court
Collection Agency ndash negotiate your fees (28 to 45 of collections)
Questions Thank you for attending
How to contact us infodaileybillingcom
Yvonne Dailey CPCCPCI ydaileydaileybillingcom
Website wwwdaileybillingcom
Resources United States Postal Service wwwuspscom
Netdeposit ndash wwwnetdepositcom Online Merchant Vendor
Useful websites www411com wwwyellowbookcom
Example letters Yvonne Dailey-Dailey Billing Services wwwdaileybillingcom
15
Skip Tracing Methods- Let Your Monthly
Statements Do the work For YOU
Use your Postal Service - Ancillary Service Endorsements
Return Service Requested
Temp-Return Service Requested
Address Service Requested
Change Service Requested
NCOA-Link services
Letting Monthly Statements Do The Work For YOU
NCOA-LINK
16
Internet Skip Trace Many different websites to assist you
www411com
wwwuspscom
wwwgooglecom
Other people search sites
The cost vary from $100 to $35000
Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People
Name Age Previous
Cities DOB Phone Address Avg Income
Avg Home
Value Relatives
1
Yvonne D
Dailey
38 Bradenton FL
Oneco FL
Randall T
Dailey (40)
Connie Y
Dailey (70)
Thomas M
Dailey (70)
Constance Y
Dailey (70)
William F
Dailey (36)
2
Yvonne D
Dailey
41
Long Branch
NJ
Albuquerque
NM
Toms River
NJ
Delroy A
Dailey (40)
Bill Dailey
Mr Dailey
3 Yvonne D
Dailey
52
Austin TX
Claremore
OK
Spicewood
TX
Camille
Yvonne
Dailey (52)
Jon Dailey
Perform written as well as oral communications Use the collection letters
Call the patient if over 60 days
Offer a payment plan and stick to it
Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place
17
Small Claims vs Collection Agency Know when to cut your losses and at what price
Regardless of route you use you will need to prove your collection efforts
Small claims will cost you the cost of court plus the attorney fee ndash Patients fear court
Collection Agency ndash negotiate your fees (28 to 45 of collections)
Questions Thank you for attending
How to contact us infodaileybillingcom
Yvonne Dailey CPCCPCI ydaileydaileybillingcom
Website wwwdaileybillingcom
Resources United States Postal Service wwwuspscom
Netdeposit ndash wwwnetdepositcom Online Merchant Vendor
Useful websites www411com wwwyellowbookcom
Example letters Yvonne Dailey-Dailey Billing Services wwwdaileybillingcom
16
Internet Skip Trace Many different websites to assist you
www411com
wwwuspscom
wwwgooglecom
Other people search sites
The cost vary from $100 to $35000
Internet Skip Trace PEOPLE SEARCH RESULTS We found 8 people that match Yvonne D Dailey in the United States Click on the View Details or Get a Detailed Report link for more info = Available Search Again gtgt See Details on All 8 People
Name Age Previous
Cities DOB Phone Address Avg Income
Avg Home
Value Relatives
1
Yvonne D
Dailey
38 Bradenton FL
Oneco FL
Randall T
Dailey (40)
Connie Y
Dailey (70)
Thomas M
Dailey (70)
Constance Y
Dailey (70)
William F
Dailey (36)
2
Yvonne D
Dailey
41
Long Branch
NJ
Albuquerque
NM
Toms River
NJ
Delroy A
Dailey (40)
Bill Dailey
Mr Dailey
3 Yvonne D
Dailey
52
Austin TX
Claremore
OK
Spicewood
TX
Camille
Yvonne
Dailey (52)
Jon Dailey
Perform written as well as oral communications Use the collection letters
Call the patient if over 60 days
Offer a payment plan and stick to it
Never complete your collection conversation without collecting at least a third of your outstanding balance if you canrsquot collect the full balance and be sure to have a payment plan in place
17
Small Claims vs Collection Agency Know when to cut your losses and at what price
Regardless of route you use you will need to prove your collection efforts
Small claims will cost you the cost of court plus the attorney fee ndash Patients fear court
Collection Agency ndash negotiate your fees (28 to 45 of collections)
Questions Thank you for attending
How to contact us infodaileybillingcom
Yvonne Dailey CPCCPCI ydaileydaileybillingcom
Website wwwdaileybillingcom
Resources United States Postal Service wwwuspscom
Netdeposit ndash wwwnetdepositcom Online Merchant Vendor
Useful websites www411com wwwyellowbookcom
Example letters Yvonne Dailey-Dailey Billing Services wwwdaileybillingcom
17
Small Claims vs Collection Agency Know when to cut your losses and at what price
Regardless of route you use you will need to prove your collection efforts
Small claims will cost you the cost of court plus the attorney fee ndash Patients fear court
Collection Agency ndash negotiate your fees (28 to 45 of collections)
Questions Thank you for attending
How to contact us infodaileybillingcom
Yvonne Dailey CPCCPCI ydaileydaileybillingcom
Website wwwdaileybillingcom
Resources United States Postal Service wwwuspscom
Netdeposit ndash wwwnetdepositcom Online Merchant Vendor
Useful websites www411com wwwyellowbookcom
Example letters Yvonne Dailey-Dailey Billing Services wwwdaileybillingcom