Otolaryngology – Better practices for a Smooth Flow of Revenue



One of the oldest medical specialties’ in the US is that of Otolaryngology. Medical practitioners in this area cure illnesses of the ear, nose, throat and sometimes, the head and neck areas as well. This specialty encompasses the general and surgical treatment of among others, endoscopic sinus, allergy problems, sleep disorders, clinical audiology (usage of hearing aids), facial plastic surgery, ear infections, balance and dizziness disorders, and facial deformities.

Due to its widespread scope, the billing of Otolaryngology is a complex procedure. To increase efficiencies and ascertain a smooth flow of revenues, along with ensuring the reimbursement of every dollar spent on patients, the following practices can be implemented:

Codes: Use specific surgery codes (e.g. ICD-10) while relating to claims and other EDI (Electronic Data Interchange) processes. For maximizing revenues, the billing team should be well aware of laws and acts such as HIPAA, Healthcare Reform Bill, and the Affordable Care Act. Knowledge of Otolaryngology specific codes and CPT (Current Procedural Terminology) codes is mandatory for the billing team to document appropriately and avoid claim denials (especially Modifier 50 -a common billing issue and CPT code 30520 – septoplasty in Otolaryngology leads to refuting claims resulting in a revenue deficit).

Education: Training programs should be conducted for the staff at regular intervals to keep them abreast of the latest coding requirements and billing procedures in this specialty. Educational tools, resources and online testing systems can enable the billing team to be well informed and/or assess if requiring added training and assistance.

Financials: For billing and coding, it is important to streamline all processes leading to submission of claims. Keep the outstanding of A/Rs well under check of 35 days or lesser. Make certain that patients are authorized for reimbursements (check their demographics and insurance information before setting up an appointment). Also, ensure that they are aware of the new contract (if any) and payment rates; re-negotiate if the need arises with the payers.

Billing process: This can be improved by regularly updating the billing software and methods, newer technologies and evaluations which can increase revenues. Moreover, healthcare audits should be conducted at frequent intervals. These lead to a lesser number of rejected claims or penalties due to inaccuracies.

Purchasing Power: A significant factor by which medical practitioners can benefit from is hearing aids. Patients should be able to buy hearing aids from the physician they are consulting rather than from outside.

EMR (Electronic Medical Records): Form a paperless practice. It creates space rather than a storage of files, documentation of patient records gets easier, and further eliminates costs that are incurred in office supplies and transcription. EMR can be documented in a few simple steps. Patient history becomes easier to be viewed, along with billing being easier as no added data is required.

Reports: The billing team should conduct a regular check on ‘Key Performance Indicators Report.’ This report gives an idea of the RCM process along with the identification of problem areas and changes required. Also, a ‘Top Carrier/Insurance Analysis Report’ should be regularly viewed as it gives the complete Revenue Cycle Metrics and a view of the overall business.

Healthcare industry rules and regulations change constantly. It is vital for the billing staff to stay conversant for improving revenues, and maintaining cash flow and profits at a healthy pace.

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