- Current practice analysis and development of a recovery plan.
- Bring pending receivables up to date.
- Codes entry for each patient.
- Electronic/Paper submission of bills.
- Verification of insurance coverage.
- Analysis of EOB’s.
- Rejection analysis, correction and re-submission of claims.
- Submission to secondary insurance.
- Direct patient billing.
- Denial Management.
Dr. Sinclair finished a gastroenterology fellowship 4 years ago, and established a practice shortly afterwards, in a small city with a population of approximately 52,000. Being the only gastroenterologist in town, her practice blossomed. A busy practice, combined with her academic commitments, left her little time for oversight of her billing practices. The staff turnover was relatively high, and reliable personnel were difficult to find. This left her income vulnerable to a frequently changing staff, with differing levels of billing expertise in her office. Attempts were made to improve reimbursement by purchasing practice management and billing software, and increasing staffing levels to assist with data entry, EOB reviews and phone calls to insurance companies for eligibility and denial resolution. However, despite the increased staffing and spending $4,800 in updated software, the reimbursements never rose above 82%.
These deficiencies were primarily attributable to lack of employee oversight, combined with a high employee turnover. Dr. Sinclair’s income fluctuated significantly with employee changes, and there was a significant backlog of uncollected bills. The employees would work from 8 am to 4 pm, and when 4 pm came, everyone went home, regardless of the number of pending denials left to be addressed the next day. This led to persistently pending claims and denials, which were left to expire un-addressed, leading to low rates of reimbursements.
Current Practice Analysis