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The Definite Guide to Wcb Billing Number Physician And Clinic C724

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Tutorial as toWcb Billing Number Physician And Clinic C724

Q: A biller had contacted me saying that: “Ican’t seem to get my first claim transmitted without some type of denial coming back.I am checking the CPT and ICD-10-CM codes and it all links together.What is going on?”A: The first thing is, there is an initial step that medical billers must take beforethey review thecoding for a claim submission.Unfortunately, it’s the reality of the billing world where they have to focus on the competencyof the practice’s front desk, and you need to monitor the denial trends because a lotof them point to the front desk.Billers don’t have time to appeal every denied claim, which can take anywhere from5 minutes to over 2 hours.If you happen to work for a practice where the front desk is horrendous and they haven’tmade any changes, then what I say is that every medical biller’s first step shouldbe to review the registrations prior to reviewing the coding or anything else.That would be the first step in the process.Over 56% of claims denied due to the front desk.That is an average based on, I own a billing service which my family runs, but I look atthe stats and stuff so that I can share it with my students, and some practices may have30% denial rate and other practices have 70% all based on bogus information because thefront desk is not doing their job.What you need to do as a biller is look: Is the front desk a qualified professional whois focused on the job?Medical billers, they require the front desk to understand the insurance, to verify theinsurance and all the patient information before they’re seen by the doctor or healthcareprovider.When the biller gets the information, the service has already been provided.So, if there is no insurance or any patient information is wrong, it’s very hard andit’s an extra step for the biller to take in order to get the claim paid.Even though working a front desk is not really difficult, if you do not work well in a chaoticenvironment, it’s not the place for you, so even if you are confident or your frontdesk person presents well, if they don’t work... you know, with folks coming in, patientis coming and going and people milling around and copayment is being collected, then youneed to make some changes.The next slide, when I asked: Do the billers actually know what the insurance is about?This is an actual insurance card that I’ve taken from a billing company and just whitedout important information.If you look at the bottom where it’s highlighted, it says United Healthcare Group Medicare Advantage(PPO).Medicare patient comes in, they have a Medicare card and they have this new Medicare PartC card, they hand it to the front desk.The front desk registers Medicare primary and this is secondary.When the biller gets an EOB (Explanation of Benefit) with all these denial codes, CO109,saying the patient has other insurance.It’s usually because they have a Medicare Part C. So, you focus on the United Healthcare,you look at the bottom where it says Medicare Advantage, and that’s your hint.The other thing to keep in mind is that billers have a year to bill Medicare.United Healthcare PPO, you have 90 days.If you don’t act on that Medicare denial within the 90 days, you put the right informationin, you won’t get paid.So now, the biller not only has to go in and make the correction to the registration, nowthey have to appeal the claim because it was billed wrong, they have to send it to theright insurance carrier.This next slide is just a very clean example of a scanned card of what it should look likein the medical record whether it’s scanned in the EMR or if it’s in a patient chart.Everything should be clear and it has everything in it from the member name and ID number andall the information, co-payments.The only thing missing in this particular back of the card, you don’t have the mailpaper claims but you also don’t have the EDI of the payer, transmitter ID number, whichis very important if you’re billing electronically.But this is what an insurance claim should look like.Let me show you legitimate bad claims that have come from my office from one practicewhere a biller actually went – you can go to the next slide – and these two particularclaims got denied.She went into the medical record and this is what was scanned.Now, you should be able to read the patient’s name as well as the ID number, and you don’tsee it.That means now that the biller has to contact the patient to get the information becausethe front desk didn’t check to see – 1) they registered it wrong; 2) they didn’tscan the cards properly or make copies to put in the chart.These are real life pictures of what billers deal with.This is what you get.If your front desk is doing this, you need to do something quick.Next slide has to do with the front desk educating the patient.This is just maybe a sign that’s out there: “Copays are due prior to services rendered.”What does that have to do with the biller?Well, the patients and doctors are contracted with the HMOs or PPOs that they have to collectthe copayment at the time of service.If they don’t, once the claim is paid, the biller now has to send a bill for $20 to thepatient to get paid so that’s not only the biller is telling the doctor is paid for,it’s all the stationery, the postage or whatever.If the patient doesn’t pay the first time, they have to pay for postage again; so a lotof extra work that the biller has to do when by right when they get the encounter formand there’s a copayment that was paid, it should be on there already.This next slide is really interesting; I actually did this up because obviously I can’t usethe real patient’s name.We had a patient, Joey Serino, that came in, filled out a registration form, he wrote downon the registration form his ID number...When the patient filled in the registration, he wrote Joey Serino.What happened was, the biller transmitted the claims and this is an example of an electronicacceptance and rejection report.Let’s say that two of the claims went through and we got the accepted report, but the bottomone says: Joey Serino rejected.Reason for rejection: Name and member ID do not match.When we looked up the card, it happened to be legible and it says Joseph R. Serino.He wrote down his last four digits of his Blue Shield as 9989, when in fact it endedin 98; he transposed the last two numbers.The front desk, if they’re the ones registering, is supposed to take that information fromthe card and make sure it’s accurate.1In this case, when you get an electronic denial, you’re not going to get a paper explanation1of benefit.1This is your denial and you can go in and make the corrections and refile it right away.1But unfortunately again, the biller has to go in and correct the registration, correct1the ID number, and then refile the claim.1These incidences has happened so much that it’s ridiculous, and it’s very frustrating1because there’s enough to do as a medical biller without having to go back and call1patients or make corrections for something as simple as this type of information.1The next one is just simple again; I had to type it out to change information.1But if you look at the bill, it’s for $210.00.1They allowed zero, paid zero.1The paid code in this particular instance is T, which means member not eligible on date1of service, which means the front desk did not verify eligibility, which means again1the biller has to contact the patient, get the correct information in order to bill and1you have to do it as soon as you get the denial because you’re dealing with anything from160 days to a year, but usually 60 to 90 days is the limit you have to bill a claim, so1you want to act on these denials right away.1Basically, the very last part here, this is a little chart of all the roles of a medical1biller, and I just covered 01 –patient registration – and I will touch on everything else in1other webinars and pretty soon we’ll be having weekly student question and answers1and I’ll be touching this as well.1Patient registration, like I said that’s the most important aspect of the billing.1If you don’t get that right, it doesn’t matter if the doctor charged a thousand dollars1in surgical procedures in the office, he won’t get paid unless that’s done.1So, you need to have to re-educate the front desk person or bring someone else in that1can handle the job because as you can see there is a lot that a biller has to do and1to be doing this very first step.1It is being proactive but it’s unnecessary.1That’s it, thank you.

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