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- Are you charging your pro and tech fee’s correctly? We found hundreds of clients were not charging the pro fee’s in most of the CDM’s we analyzed resulting in millions on lost revenue. We also have designed simple systems where you can simply type in your CPT code and we will tell you if it should have a professional fee attached.
- Are your fee’s accurate? If your contract is % of charges while it may not impact your APC payments, but it will have a large impact on commercial payers. This all depends on your contracts. For most of our clients we help them analyze contracts versus CDM’s to be sure they are charging above the APC rate.
- Do you know how much cash you will receive for the following month? We found so many clients simply just are surprised with cash shortages. It is not that hard. The easiest way is to take your last year or two of gross charges by area (clinic, hospital, LTC, SNF, etc.) then get the following month payments by area and get a percentage of previous months gross to the following months actual payments. If you do this for about the past 12-24 months you will then be able to get an average % of collections between gross and net. With enough practice and tweaking you will see that you typically can estimate within 3-5%. While this is not the best way it is the easiest if you do not have a contract management system. We typically would come in and setup a contract management system that knows when you bill your gross exactly what your net will be thus our cash projections are within 1%. We have helped so many organizations that set unrealistic budgets yet had no idea they were in-realistic until we showed them they could never hit the budgets they set.
- Are you charging OBS hours and inpatient correctly? We have found that so many organizations do not have this setup correctly and are missing so much revenue because they do not know you can charge OBS hours up until midnight the night before, then inpatient the next day (after midnight). We have helped our clients with this and hundreds of other charge capture missed opportunities.
- Do you charge your Infusions correctly versus pushes? So many organizations charge for the push and not actual infusion. You just have to be sure you are documenting your start and stop times correctly.
- Do you have daily charge reconciliation processes in place in all departments. If not STOP RIGHT NOW AND CALL US! Kidding, but this is crucial. We have found in every single organization we went into they were missing hundreds of thousands of dollars in lost charges. Whether you use paper charge tickets that someone else enters or the physician themselves entered, charges are always missed. You need to have a process in place where you compare your schedule to the patient visit to be sure the correct charges are entered daily and reconciled.
- Are you monitoring late charges? Be sure you have a process setup that looks at the date of services versus the date of entry that the charge was put in. It is critical to get your charges in, in no more than 3 days at the maximum from service. This can have a huge impact if it is not occurring. Your DNFB will rocket or if you bill missing the charges you then will have to re-bill. This just overall creates a mess and is one of the main areas we always assist our clients on setting up a late charge and overall charge reconciliation process.
- Do you monitor your AR daily? This is a must! You should have an easy tool even if in excel where you can monitor claims moving from days 30-60 into 61-90. Depending on your timely filing limits, this has the potential to be lost revenue. We have seen most clients that we go into lose hundreds of thousands of dollars and some lost millions in just simply letting claims “fall off the cliff” for timely filing simply because they were not monitoring AR. We have built custom systems for all of our clients that monitors this automatically by pulling in the ATB’s daily and being sure not a single claim is every missed. Our systems that we build for free, monitor and automatically send to a biller or claims follow-up person for review and if not resolved then alert the management.
- Have you updated all your radiology / X-ray codes? The new CPT’s require this and all the old codes will no longer be accepted. For our clients we do a full CDM review and always notify you well in advance.