December 22, 2015
More often than not wound centers provide excellent services to their patients. However, when it comes to billing, they seem to be beset with issues, which are quite annoying. While billing, the medical of the patient needs to be reviewed thoroughly, describing the dimensions and the procedures adopted in the management of the wound. Under these circumstances here are a few significant issues in wound care billing.
The primary requirement is to understand the very basics of billing and coding by which the insurance companies along with the authorities in the government go before making payments. They want to make sure that all the regulations are followed while coding. It is not enough to get paid; the centers need to make sure that they are quite well protected from the prying eyes of the recovery audit contractors who go through the bills with a hawk’s eye, looking for anomalies.
One can’t ignore the RAC auditors who have wound care very high on their list of priorities. It appears all the RAC wants to do is to take back the money disbursed to centers, even when the claims are legitimate and the documentation is perfect. What with a string of reimbursement cuts over the years, it is important to make sure everything is in order before submitting.
Hospitals are already working on very thin margins, and to compound that there are declining reimbursements. It is necessary to focus as much on patient care as it is to focus on the financial standing of the institution. Wound centers need to build healthy relationships with the hospital business offices they deal with. In case there are an unusually large number of denials, the center needs to understand why such denials occurred and prevent future occurrences.
The insurance authorization and verification process is quite complex and the staff at the center need to start the process even before a patient presents herself or himself at the clinic. Although it is alright to trust the recommendations and referrals that come along with insurance information, it pays to verify all such information well before the very first visit itself. The verification needs to continue on a regular basis.
The staff in charge at the wound center need to be well trained in all aspects of billing and coding. As clinicians and physicians do not have the time or inclination to know the intricacies of billing and coding, it is up to the health information department at the hospital to take the initiative. Physicians may be offering high cost treatments, little knowing the consequences, especially when cheaper alternatives are available.
Most centers may not have in-house billing and coding provisions. The health information department staff may be taking care of the coding and the business office may be handling the billing. That’s why it is all the more important for the wound centers to have a good relationship with the business office. It also pays to be updated on all government regulations with regards to billing and coding, and all documentation needs to be reviewed for accuracy.
While patient care is of paramount importance for any wound care center, it is equally important to offer patients a cost-effective solution for the healing process. This balanced mix of care and cost leaves all in a win-win situation.
Accounts Receivables / Claims Denials