Get Paid in Full for Your Home Infusion Services
By: Cheri Sciacca, Mediware Reimbursement Services
It’s no secret that billing for home infusion supplies and services is a complex process, and mistakes are not uncommon. These errors, which could result in denials or could mean lower reimbursement due to failing to charge for all the products and services you supplied—means you aren’t getting paid what you’re owed.
Even those of us who specialize in infusion billing experience the headaches from time to time. However, over time, many of us have developed strategies for conquering the challenges. Here, from specialists in home infusion billing at Mediware Reimbursement Services, are tips for addressing the five most common struggles.
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Five common home infusion billing challenges
- Problem payers:
Many times, denials occur because your claims are being processed electronically—without a manual review—or because payers lack understanding of infusion coding. Often, expert billers know more than the payers themselves because IV billing can be hard to understand. If this is the case, be patient, and explain as best you can.When you make contact with the payer, start with your customer service rep and then escalate to a supervisor if your issues aren’t resolved. Sometimes, you may reach a rep outside the U.S., but domestic reps may be available. If your problem remains unresolved, ask for an on-shore representative, which may make communicating your issues easier.Also, most payers, have a designated provider representative for claims and contract issues. You may need to contact one of these reps if your issues remain unresolved after multiple attempts.
- Partial payments:
If only one line of a claim is paid instead of all charges on the claim, you may need to research to uncover why the payer didn’t pay the entire amount. You should review the claim (in your system) line-by-line and see what charges did not pay (in full or partially). From there you will need to research why the amount of revenue you booked did not match the amount of cash paid. There are a multitude of scenarios that could apply. For example: It could be that you don’t have the most current fee schedule. It could be that you don’t have an authorization for part of the claim or that the authorization on file expired mid-way through the dates on your claim. Either way, it is necessary take the time to review the claim and the details in its entirety to determine the problem and or root cause. Lastly, it may require contacting the payer directly to identify the discrepancy.
- Collecting from patients:
The way many payer plans are structured today, patients often share the cost of their care through copays (either a fixed cost or a percentage of the charges) and deductibles. Ideally, you should check their benefits and know their portion of the charges in advance so that you can collect that amount up front. Most patients or their families will pay anything to get the treatments in the home setting versus remaining in the hospital or nursing home. However, if you wait until the therapy is complete, the urgency no longer exists and the funds are often no longer available.
- Working aged accounts receivable:
The reality in home infusion collections versus other areas of healthcare collections, is that because of the complexity of the claims, they often take significantly more time (on average) to resolve. A perfect example is that most services are not covered by Medicare. It can take you months to get a “proper” denial from Medicare to bill the secondary payer. Thus, you must ensure that you are closely monitoring every claim to ensure it does not become bad debt. For A/R that is over 120 days old, follow up with payers every 30 days, and make sure that you know the status of your claims. After 180 days, evaluate claims to see what amounts are due. Because Medicare closely monitors claims and denials, a few denials can lead to more denials and audits. Therefore, when billing Medicare, be sure that every detail is addressed. Analyze your software and the A/R tracking to be sure that nothing is missed. You should ensure you have all documents (such as DWO, signed packing slips, DIF, etc.) before submitting your claims to Medicare. The claims should be held until you have all the required documentation in place.
Adjust your communication to fit your audience. When conversing with patients, who may not understand why they have copays and deductibles, speak to their needs and explain the situation in ways they can understand. When working with payers, who may not understand all the details of infusion billing like you do, try to explain the details necessary to get your claims paid without making the CSR feel inadequate.
You may also have internal stakeholders who want to know how their businesses are doing, so you’ll have to learn to adapt your communication with them as well. In these cases, you may also want to use the reporting tools in your system to provide information about past due claims as well as those that were reimbursed with no problems.
To ensure that your home infusion billing is accurate, so that claims are paid quickly, contact Mediware Reimbursement Services. We can help you reduce your bad debt and increase collections today.