Some of these are generics, but specific steps can be taken using these:
Ten Steps that can be taken to improve the performance are as follows:
1. Assign a client manager: This person will be the only one communicating important information to the client. E.g. a code is being discontinued. This person will monitor everything every closely for trends. She/he will not be billing or calling on insurance companies unless there is a very difficult account that they are having problems collecting on. This person will do random audits every day, week, month and quarter. He will do random audits on drugs and inform us if the drug is not getting paid. This person will know which insurance is not paying on time and which is. This person will have inside out knowledge of oncology billing and can identify minor problems without much research. E.g. if Medicare is asking for Medical records, there is something wrong somewhere. This person will call the client at first sign of a system wide problem and will acknowledge being accountable for his team.
2. Use code correct: Before informing client of any code changes, it should be researched on code correct. Further, code correct's Coach Section should be used extensively to post coding related question instead of asking the client with questions.
3. Clean claims: The mission statement of the company should be to submit clean claims. It starts with demographic entry. How can we improve demographic entry to avoid mistakes? It can be done at Insurance and benefits verification stage. This step should be given UTMOST importance. One very knowledgeable person should keep a close tab on every patient that is scheduled to receive service in the clinic. Special focus should be placed at patients coming for high dollar procedures.
4. Denials Analysis: EVERY DENIAL should be analyzed and tracked. System wide problems should be identified and client should be notified IMMEDIATELY. Client manager should be the one taking a lead in reviewing denials and informing client as to why we are getting denials. How many are because of billing errors. How many are because of client's errors. Denial patters should be studied and shared with the client. If a particular drug is being denied because of preauthorization it should be identified at first denial and informed immediately. There should be system wide red flags that should be raised on every denial that shows a system wide problem.
5. Training: Billers should know the usual billing units. Payment posters should know the usual payments. They should be trained and tested on regular intervals for this knowledge. No exceptions to this should be made.
6. Technology: Use technology to the fullest. Every insurance company's website should be used to check on claims, eligibility and benefits verification etc if such facility is available.
7. Thinking out of the proverbial box: There should be a culture to think and question everything. If OH Medicaid is taking three months to pay someone should be questioning: why? Why should it take more than 30 days to get paid form anyone? Can we do this electronically?
8. Follow up: if you write that you need to follow up on a claim in 3 weeks, do it in 3 weeks and not in 3 weeks one day. Immediately create a reminder for you using Microsoft Outlook Express Task Management function that will pop up in 3 weeks exactly.
9. Fix things before they go out of hand: Don’t wait for things to fix themselves. Don’t do a patch up job. If things can be fixed for good by changing a process, suggest it.
10. BE PROACTIVE: Bring issues to the client instead of client bringing these issues to you. Analyse reports. Point problems. Suggest solutions. Do proactive audits yourself. Audit every patient once they finish the treatment for billing accuracy. Proactively resolve issues.
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