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List of Figures, Tables, and Forms xii
Preface ix
Acknowledgments xi
About the Coker Group xiii
Getting Ready for a Self-Assessment 1
Gather Data 1
Understand Your Practice Information 3
Perform a Cursory Review 4
Summary 5
Tracking the Patient Encounter and Interviewing Front Office Staff 7
Review the Patient Encounter 7
Interview the Front Office Staff 8
Practice manager 9
Receptionist 9
Billing clerk 10
Insurance specialist 11
Summary 11
Completing the Analysis 13
Accounts Receivable 13
Collection Levels 14
Departmental Administrative Direction and Leadership 15
Operational Organization 16
Computer Systems and Associated Processes 17
Upgrade the system 18
Establish electronic claims filing 18
Use a lockbox service 18
Department Personnel Training 19
Policies and Procedures Manual 19
Adjustment Process 20
Copayment Collection 21
Patient Education 22
Staffing Levels 22
Management Reports 23
Charge Capture 23
Compliance Plan 26
Internal Controls and Cash Handling 27
Coding 28
Managed Care Information 29
Physical Facility 29
Summary 30
Setting Up Billing and Collections Operations 31
Identifying Roles and Assigning Responsibilities 31
Employing the Right People 31
Establishing Payment Policies and Fees 33
Using Performance Standards for Collectors 37
Rewarding Performance Through Bonus Plans 38
Applying Coding Knowledge 38
Summary 39
Getting Paid by the Patient 41
Collecting at the Time of Service 41
Offering Discounts for Cash Payments 43
Confirming and Gathering Copyaments 47
Recognizing the Importance of Copayments 49
Collecting from HSAs, HRAs, and Other High-Deductible Plans 50
Establishing Collection Goals 51
Making the Most of Balance Billing 53
Understanding Usury Laws and Finance Charges 57
Charging for No Shows 57
Summary 58
Getting Paid by Insurers 61
Verifying Patient Insurance 62
Using the Internet 62
Submitting a Clean Claim 63
Prebilling 64
Claims transmission 65
Payer follow-up 65
Payment posting 66
Denial management 66
Statement generation 66
Collections 66
Retrospective and concurrent review 66
Developing Payer Profiles and Analyses 68
Dealing with Slow Insurance Payers 73
Prompt pay laws 74
Recoupment of payments made by payers 74
Identifying Incorrect Payments 75
Automating Requests for Information from the Provider 76
Instituting a Follow-up System for Unpaid or Rejected Claims 77
Appealing Denied Claims 79
Using Software to File an Appeal 79
Understanding the Appeals Process 80
Urgent review 81
Appeal 81
Appeal 82
Appeal 82
Other stages 82
Filing Grievances with the State Insurance Commission 83
Summary 84
Getting Paid by Medicare 85
Know What Will and Will Not Be Paid 85
Advance Beneficiary Notice 85
Keep Up with Policy Changes 88
Submit a Clean Claim 89
Use the Medicare Appeals Process 90
First level of appeal: redetermination 90
Second level of appeal: reconsideration 90
Third level of appeal: administrative law judge 91
Fourth level of appeal: Medicare Appeals Council review 91
Final level of appeal: federal district court review 92
Use of Medicare Electronic Data Interchange 92
Pay Attention to Fraud: Compliance Should Be Part of Everyday Billing Practices 93
Summary 94
Managing Parallel Payment Systems 95
Manage on the Front End 95
Manage on the Back End 97
Capitation: Verifying Coverage and Monitoring Utilization 97
Billing for Fee-for-Service Carve-outs 99
Summary 100
Prompt Pay Statutes and Regulations 101
Resources 111
Glossary 113
Index 139
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Add Maximizing Billing and Collections in the Medical Practice, Today's shrinking physician reimbursements and rising costs for health care delivery, necessitate medical practices to have analytical tools and review processes in place to maximize their billing and collections efforts. Medical practices are experiencin, Maximizing Billing and Collections in the Medical Practice to the inventory that you are selling on WonderClubX
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Add Maximizing Billing and Collections in the Medical Practice, Today's shrinking physician reimbursements and rising costs for health care delivery, necessitate medical practices to have analytical tools and review processes in place to maximize their billing and collections efforts. Medical practices are experiencin, Maximizing Billing and Collections in the Medical Practice to your collection on WonderClub |