How to Prioritize Your Home Infusion Billing Tasks to Maximize Reimbursements
By: Diane Maxim, Mediware Reimbursement Services
When you have multiple home infusion accounts to work, all with strict timely filing deadlines, you must prioritize tasks to ensure that everything gets done to ensure that you get paid. While the temptation may be to focus only on the largest dollar amounts first and then turn your attention to smaller accounts, that approach could end up costing your home infusion business money if you don’t get to the other accounts until they are past timely filing.
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A better and more dollar-wise way to manage your work is to sort by payer, timely filing limit, and then high dollar, so that you spend your time first where it counts the most. Read our tips below to ensure that you are focusing your efforts where it will lead to the most overall financial gain for your business.
- Use reporting tools to prioritize. Managers and Reimbursement Coordinators (RCs) should run financial reports at least once a week, and sometimes daily, especially if there is a backlog of issues that need to be addressed.
- Analyzing reports such as claims past due, denials, claims with zero notes, and partial pay reports are great tools that can help determine which accounts take priority and need to be worked first and which ones can go on the back burner. With aging reports, it is important to identify your top 100 patients that have the highest balances, and to keep the follow up on these accounts current. Even if some of these patients are hard to deal with, it matters that you follow up with each of them.
- While you are in each patient’s account, it may be worthwhile to review all the claims to ensure they are done correctly. In some cases, you may find that you have multiple issues on one patient account. By reviewing the entire account, you can appeal all outstanding claims at once.
- View claim status online. Most payers allow providers to submit and appeal claims online. Make sure you have key information available regarding your claim(s), and visit the website to monitor the status of the claim and, if denied, determine the next steps. In some cases, this may eliminate the need to stay on hold with payers for hours, and you can get the answers you need immediately. Don’t assume your payers don’t have on-line claim status because when you last checked it was not available as payers are constantly making improvements to automate the claim process.
- Manage credit balances as time allows. Apart from governmental overpayments, which should be refunded as soon as possible, credit balances should be a lower priority. It is important to look at accounts with negative balances to determine if revenue was underbooked or if an overpayment truly occurred. Next you will need to determine the payer’s process. Do they want to issue a refund or do an offset.
- Evaluate claims that are after your specified filing limits. Unless there is a clear, justifiable reason, submitting claims past the timely filing limit may not bring in any additional cash, but it is always worth a try.
- Review the terms of your contract, know your limits ahead of time, and plan accordingly so that all claims are submitted before the time expires. Each payer has different filing guidelines, so don’t assume that all payers are the same.
- Each week, RCs should work their claims within 7 days of the follow-up due date.. Once these are completed, move on to newer claims.
Being a home infusion RC means juggling many different things at one time and being able to determine which accounts take priority over others. By analyzing reports, claims by payer, filing limits, and patient-specific account information, RCs can manage their workloads, so claims are addressed in a timely manner and NEVER become a problem.
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