Accounts Receivables Maturity in Billing Organizations

Accounts Receivables Maturity in Billing Organizations

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  www.exdionrcm.com USA | UK| INDIA Copyright © 2019 ExdionRCM Accounts Receivables Maturity in Billing Organizations
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  www.exdionrcm.com USA | UK| INDIA Copyright © 2019 ExdionRCM Introduction Stringent compliance and procedural complexity pose major challenge to anesthesia billing. Coding errors, inaccurate billing, delayed or denied claims affect the viability of service providers. This white paper will discuss the existing challenges faced by anesthesiology billing practices and the solutions that ExdionRCM can offer to ease the complex billing process. Anesthesia Billing: Complexity and how hospitals and service providers lose out on revenue realization Anesthesia medical billing isn’t like other forms of billing that clinics and hospitals might face. There are stringent, federal guidelines to be followed. Anesthesiologists spend most of their work days with patients and it’s easy to let billing fall to the wayside. However, the right software application can make a huge difference. It’s equally significant to patients that anesthesiology is billed correctly. One minor mistake can lead to an expensive, unmanageable bill. There’s no room for error.Anesthesia payment is calculated by a simple equation of base units, time units and participating conversion factor. Unfortunately, even if an anesthesiologist has a qualified office manager in charge, errors sometimes happen. Even if a slip-up is caught, it can take months to correct once insurance companies are involved. Overheads to providers can be daunting and patients might get burdened with a greater bill than estimated. The only way to enhance this system is by streamlining the process. A common software application that associates everyone involved in the hospital, including the doctor, takes human error out of the equation. Double entries are automatically eliminated. ExdionRCM’s Robotic Process Automation (RPA) through its unique E-BOTS -has a lot of promise. RPA is the application of technology that allows configuration of computer software or an “electronic robot” to handle high volume, highly repetitive, rule-driven activities so that losses due to human error and attrition could be eliminated. ExdionRCM also helps the partnered anesthesia billing companies by providing trained expert coders. The partner organization can thus enjoy the fruits of efficient, expert coders without having to worry about their recruitment or training. When medical billing has errors, issues with reimbursement to anesthesiologists are common. Busy practices might not catch these errors till found and it may sometimes take up to a quarter to be reimbursed. This means that doctors are primarily providing their expertise for free. There’s no purpose to settle for a hit or miss approach to billing. ExdionRCM also helps the partnered anesthesia billing companies by providing trained expert coders. The partner organization can thus enjoy the fruits of efficient, expert coders without having to worry about their recruitment or training. When medical billing has errors, issues with reimbursement to anesthesiologists are common. Busy practices might not catch these errors till found and it may sometimes take up to a quarter to be reimbursed. This means that doctors are primarily providing their expertise for free. There’s no purpose to settle for a hit or miss approach to billing.
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  www.exdionrcm.com USA | UK| INDIA Copyright © 2019 ExdionRCM Major Factors for Revenue Leakage Anesthesia billing suffers from following challenges Coding complexity: Billing for most specialties involves a limited number of relevant CPT code sets – for example, perhaps 10 to 15 codes in obstetrics – with which coders become greatly familiar. Anesthesiologist performs various actions in the operating room and hence anesthesia billing comprises nearly all of the 13,000-plus procedure codes. - This requires greater coding efficiency to get the complex codes right. Absence of such highly skilled workforce results in greater revenue leakages in anesthesia billing. Time-based services: Anesthesia is exclusive among hospital services in that reimbursement depends in part on the amount of time spent in providing care. All extra services are reimbursed at fixed rates that match to current procedural terminology (CPT) codes. Anesthesia payments depend on codes plus actual stop and start times. -If the coding staff is not familiar with the unique billing process, this adds to causal list of errors in billing. If a procedure is documented at a low level of detail that could apply to more than one opportunity, it may be billed for the procedure with the lowest reimbursement. If the start-stop recording is petite by as little as ten minutes, a full-time unit will not be un-reimbursed. When these errors are part of a tenacious pattern and they often are the facility can slip out on a large amount of dollars per year that it really should receive. Sources of Anesthesia Compliance Issues These are some of the anesthesia’s unique documentation and compliance issues, which can subject hospitals to regulatory action in adding to under/over-billing. These comprise: Concurrency: Anesthesiologists can medically direct, and obtain full payment for, up to four concurrent cases. Even a single minute of overlap on a fifth supervised case can cause CMS to decrease payment in all five cases. If the billing system doesn’t automatically check for this error, –or if the billing team fails to check manually, the result can be fraudulent billing and substantial over-payments. Medical direction: -Medical direction is a special scenario with unique payment rules that occurs when a physician anesthesiologist works with one to four other qualified providers (Certified registered nurse anesthetists and anesthesia assistants) in overlapping cases. If more than four cases overlap, even for a single minute, this is considered to be medical supervision. Most payers will not reimburse the anesthesiologist for this service. When these tasks aren’t documented as having been finished, billers with insufficient anesthesia experience often inaccurately file claims as medically directed, representing unintentional fraud. Modifiers: -. Modifiers in Anesthesia billing is added to the procedural code while billing. Modifiers such as physical status, age and emergency factors may be added to the procedure code. The total number of units is then multiplied by a conversion value to create a total charge for the procedure. When billers are not fully aware of modifier usage, the result can be inappropriate billing and over-payments. Start-stop time: According to the CPT guidelines, billing time for Anesthesiologists is the exact time in minutes that the doctor spends with the patient in preparation and administration of the drug. Recording and reporting discontinuous time spent by the Anesthesiologist, wrongly billing time when patient is in holding area are major cause of errors causing revenue leakage.- This is watched -closely by the Medicare Recovery Audit Contractor (RAC) program.
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  www.exdionrcm.com USA | UK| INDIA Copyright © 2019 ExdionRCM Key areas where ExdionRCM expertise will help improve your business capabilities Best practice adoption: Exdion has closely worked with billing service providers. It has qualified professionals who help the companies improve RCM challenges but also adopt best practices from the industry. It will not only provide efficient process insights but will also provide well-trained coders. An effective document management system is put in place to improve compliance. Robust technology platforms: -To further reduce billing errors, technology can be used to automate repetitive activities. ExdionRCM’s innovative Robotic Automation technology with its E-bots increases process efficiency. Consequently, revenue leakages reduce. Efficient RCM hence improves the business performance of the partner organization. Cutting edge Medical coding: -ExdionRCM provides to all its partner organizations, a large pool of expert medical coders with a deep understanding of the anesthesia billing process. These coders have the knowledge of the complexities involved in the billing calculations. Recognized Excellence in anesthesia billing: - With improved compliance and reduced billing error rates, ExdionRCM partner billing organizations can enjoy excellent testimonials from their clients. Increased ROI and billing expertise can be proudly showcased. HIPAA compliance in billing: -Having worked with various clients in Anesthesia billing, ExdionRCM understands the need for regulatory compliance. Experts help the partner billing companies in advising them on HIPAA compliance issues by keeping track of the federal and state-made changes in the complex regulatory environment. Cost Advantage: World-class billing proficiency that ExdionRCM offers to its client comes at cost advantage to the partner Anesthesia billing firms. Having outsourced the complex billing process to ExdionRCM, partner organizations also saves themselves the pain of recruiting and training the expert coders. Conclusion With ExdionRCM as your partner, you can be assured of world class service at affordable cost. ExdionRCM brings best practice insights, process efficiency and people expertise to make you win against the competition, always!. We are proud to have removed the pain out of Anesthesia billing for our partners and bring more moments of smile on their face. To know how we can help you address your anesthesia billing, Please contact [email protected] for more details. For more information visit us at- www.exdionrcm.com or [email protected] Follow us on- About ExdionRCM: ExdionRCM comes with over 15 years of Insurance Process Management expertise. ExdionRCM services clients ranging from Fortune 500 to small and medium sized healthcare businesses. ExdionRCM is ISO 9001 certified for Quality and ISO 27001 and HIPAA certified for information security. The company thrives on Business Excellence and leverages models such as Kaizen and Six Sigma along with technology enablers, to continually enhance value to customers. ExdionRCM lays great emphasis on Accountability, Integrity, Innovation, Transparency and most importantly Customer Focus. ExdionRCM continually strives to deliver transformational excellence through technology-centric process optimization and continual knowledge enhancement. ExdionRCM’s solutions include Transformation Consulting, Business Process Management, Analytics and Revenue Cycle Maturity frameworks that leverage CLOUD FIRST technologies.