7 Tips for Home Infusion Billing Success
By: Cheri Sciacca, Senior Reimbursement Coordinator, Mediware Reimbursement Services
Billing for home infusion services and supplies is no easy task. Inaccurate home infusion billing can generate hours of rework and delay accounts receivable. See our tips below from our billing experts at Mediware Reimbursement Services that outline the steps that your staff can take to ensure accurate billing and clean claim submission.
When starting the billing process:
- Understand your contracts. As a biller, it’s essential that you review and understand the details in the payer contract you’re billing for. You should know the timely filing limit, what is billable outside of the per diem, and whether you are required to bill in actuals or HCPCS for the drugs. Billing staff should have copies of all contracts readily available to verify these details instead of assuming what is or is not covered. Make sure your contract fee schedules are loaded into your software platform correctly so that the revenue you are generating is accurate and not overstated. It’s also important to make sure that you’re not booking your revenue at list price versus net (the amount you expect to collect). On the flip side, you always want your claims to go out at your list pricing just in case rates increase and your contract pricing has not been updated yet.
- Verify documentation. Having the correct documentation is key to ensuring correct claim submission and payment. It’s the biller’s responsibility to review and make sure all documentation is on file and accurate before transmitting the claim for payment. This is especially important when you are billing Medicare, as you will need to make sure you have all the required documentation on file before you submit your claim for processing. These documents could include, but are not limited to:
- a detailed written order (DWO);
- DME information form (DIF);
- Advanced Beneficiary Notice (ABN) if billing for denial; and
- a signed delivery ticket.
Creating a documentation checklist reference guide is a great way to reduce human error and ensure that all documentation is complete before billing is issued. An important reminder when billing Medicare: if you transmit the claim for processing without including all of the required documentation on file, you may not have any appeal rights with Medicare. For example, suppose Medicare is looking for a DWO with all 13 elements, and the DWO is signed by the physician and dated before your claims were transmitted to Medicare-if you cannot produce this document, you cannot get paid. Thus, it is vital to get your documentation right the first time.
- Review both progress notes and billing notes. It’s important to first document each payer process then refer to these notes thoroughly before creating a claim. You should confirm what was delivered and determine if there was an interruption in the service for patient (for example: if they went into the hospital). Progress notes can also provide vital information about order changes, dose fluctuations, and any changes in insurance coverage. It’s always a good idea to review the progress or billing notes prior to billing charges to confirm there are no changes to the current service.
- Verify authorizations for services provided. Reviewing and confirming that you successfully secured authorizations for the services being billed is also hugely important. At the time of insurance verification, the intake staff should verify whether or not an authorization is required and start the process. It is the responsibility of the billing staff to verify the codes that were authorized vs. the codes that are to be billed. If there is a discrepancy in the authorized codes, it should be corrected before billing the charges to the payer. Home infusion softwares, including Mediware, have functionality to track the number of units used on the authorization to keep a running total. If your software does not have this feature, then billers must to verify the units that were previously billed on prior claims.
- Review prior charges. When reviewing the current charges in the billing queue, remember to review prior charges that have been billed in accounts receivable for the patient. Be sure to check for key information, including overlaps in date of service, code changes, and prior payment history. It is important to review prior payment history so you can identify any discrepancies in the revenue that your booking or even resolve denied claims before billing again. This will help to deter overstated and/or understated revenue adjustments in the long run.
- Follow up on claims. After sending the claim through the clearinghouse, billers should ensure that the claim was successfully accepted. Billers or the support clerk should always check if the claim was electronically accepted from the clearinghouse, to the payer. Once the claim has been accepted, a note should be entered in the claim notes in the patient’s account with a 30-day follow up date assigned to ensure that the claim has been processed and paid.
- Use industry resources for additional help. The National Home Infusion Association (NHIA) created a helpful, quick-reference billing guide that outlines the correct codes and modifiers to use when billing for home infusion services. Mediware has sponsored this guide, to help providers just like you. If you are a NHIA member, we encourage you to access this free guide through the NHIA website.
Billing for home infusion can be challenging, but with the helpful tips above, your billing department can know how to bill correctly the first time. Mediware Reimbursement Services specializes in home infusion billing and collections services that are proven to deliver results. Click here to learn how your IV business can grow your collections with Mediware’s billing team!