You might think having the least experienced person posting your EOBs is OK because:

• You save money on their salary, taxes and benefits
• It is not difficult to post EOBs – anyone can do it
• They are easily replaceable if they quit
• Young people bring more energy to the office environment

But, your practice might be loosing thousands each week due to these reasons:

1. If the person in charge of posting your EOBs is not trained or is under-trained,
   they are not experienced enough to notice when things look wrong. They will not catch the details that an experienced biller would.
   
   Under-trained personnel do not know when to appeal an insurance company's decision about a rejection or non-payment. They also do not notice the small details such as using the same CPT code your office has always used to avoid billing errors. For example, a procedure was billed as a bilateral code but on the EOB from the carrier you only got paid as a unilateral procedure; either someone billed it in wrong, or the insurance company just knocked it down to a single CPT resulting in a lesser payment to you.
   
   An under-trained EOB poster will not dispute the insurance company and will post what they receive and adjust off the balance. They do not know enough to notice when things look wrong and even if they did notice, they would not know enough to know how to research it properly.
   
   
2. If the person entering your charges into the system for claims/HCFAs is not trained or is under-trained, they will not have the knowledge to appeal when necessary.
   
   
   • How many claims are being paid improperly without your knowledge?
     
   • What happens when the insurance carrier states that the claims were previously processed, previously paid, or are a duplicate claim?
   • Do your under-trained personnel assume the insurance companies are correct?
   • Do they check the account in the computer for actual payment (not just a previous -0- payment or previous low payment that might still be under appeal)?
   
   “But... I am a busy doctor; how can I tell if my staff is carefully looking over the EOBs?”
   
   You should see notes next to the -0- payments on the EOBs for what was done to check the status such as:
   
   
   • "paid on 6/7/05"
     
   • "still under appeal notified Betty in billing"
     
   • "I called the insurance company, spoke with Michelle, got check number CB1233445555 dated 09/10/05, and checked the deposits to see if we received that check. No such number listed on deposits for the month of September. Notified Betty in Billing 2:43pm 10/2/05".
   
   
   Sometimes, the check might not arrive at your office due to a processing error the insurance company made, such as clicking the wrong doctor or practice name in their computer, and YOUR check is sent to the wrong office. Most likely it will be discovered, but it could be months later.
   
   If your staff writes off what the EOB tells them to do without researching the claim first, then you may never know - but money is flying out the window every single day. The more you let insurance carriers under pay you, the more they will.
   
   There should be a file containing a copy of each appeal letter by insurance carrier that you can review. Most EOB posters have a pile of EOB’s that are pending research and letters of appeal.
   
   A copy of the appeal letter can go in the patient’s chart in the financial/insurance section to alert the physician of possible payment problems. A copy should be kept with the appealer to go back in 12 – 15 days to see what action has occurred. Most of the billers who write appeals have form letters on the computer ready to go to each carrier to save time, as the rejection/appeal reasons are pretty standard. If your staff can’t show you these items quickly, maybe you need a better system in place.
   
   If you are currently using a billing service, and they are handling appeals for you already, you should ask for a copy of all appeals done on your behalf per month. There should be several appeals made per month if not per week, as insurance carriers do make mistakes. This is the best way to be certain you are getting paid properly.
   
   Billing services get paid to do follow-ups. If you are not getting several letters per week and/or month showing their appeal process or notations from phone calls on your behalf with dates, times, names etc, then you are not getting what you paid for.
   
   
3. If the least experienced personnel without insurance and billing training are at the front desk, they will be entering data that your whole practice will rely upon to get reimbursed.
   
   The number one reason doctors do not get paid or paid properly is because of patient data being enter incorrectly from the beginning. It is much wiser to have experience biller(s) at or near the front desk to oversee what happens, who says what, ensure that your office participates with that insurance to begin with, and if they are self paying patients – how do we know the patient will pay today?
   
   Billers spend most of their time fixing other people’s mistakes, usually from the front desk area. You need an experienced biller to know when to flag charts for patients that continually do not pay their balance, and be up front when the patient comes in to make arrangements for payment of old debt and new debt before the physician sees the patient again. Once the patient has received their medical service, their desire to make things right usually is no longer a priority because they received the service they needed and are “OTD” Out the Door - without stopping by check-out to pay on their account.
   
   
4. Use of out-dated ICD-9 and CPT codes on your Superbill.
   
   Many doctors try to save money and not buy new coding books for each New Year. They think, “Not that many of my codes have changed” or “they couldn’t have changed that much”.
   
   Actually, the codes do change enough that it is well worth the investment to purchase a 2006 CPT, ICD-9 and if needed, an HCPCS all 2006 version. Sometimes the numerals stay the same, but the meanings change. This could affect your bottom line.
   
   It is also important to make sure the deleted codes are no longer accessible in your computer system for staff to fall back on old patterns of code selection. You need to check your superbill you are using now, print out all the codes in your system for CPT report and ICD-9 report and make sure all codes in the system are accurate both to the numerals and to the meaning of the numerals, as meanings can be revised.

Eye Bill For You can help you save money.
We can review your superbill/encounter form, your fee schedule, a basic Accounts Receivable report and your EOBs for several months and for several carriers. Please visit our Services page to see what we can do for you.

About EYE Bill FOR YOU

Based in Virginia with 54 years of combined experience and a broad range of medical billing knowledge, EYE Bill For You offers HIPAA compliant medical billing for many specialties. Our medical billing outsourcing solution is offered in the Virginia, Washington DC and Maryland areas.

Cathy Boddie (owner) has an established reputation for helping doctors lower their accounts receivables by examining super-bills and improving them to increase reimbursement levels. Cathy has taught students in medical billing and coding at Northern Virginia Community. Cathy has provided lectures and training sessions on medical billing and coding, Self Pay Issues, and working with Embassies accounts at Georgetown University Hospital and Medical Center.

http://www.eyebillforyou.com

EYE BILL FOR YOU
Cathy Boddie, Owner
email: cathy@eyebillforyou.com
phone: 877-EYE-BILL or 877-393-2455

For permission to republish the above article, please contact Cathy Boddie.