How to become a proficient and effective billier?

[CIA_2019]

Hello!

What are some tips and tricks to effect and efficient billing?

[michaelharris99]

Very simple! you must try to claim the insurances as soon as possible to make your client happy and you are an effective biller. 

[CIA_2019]

What are some steps that you take to work your denied claims?

[Michele]

What are some steps that you take to work your denied claims?

There is really no simple answer to your question.  It's very vague.  The only tip I can give you is to handle denials as soon as they are received.  The quicker the better.

[CIA_2019]

Thank you

[medwave]

Yeah, this is all a bit too vague. It's dependent on what you are looking to tackle as every healthcare provider is different.

[kristin]

You have to figure out what categories the denials fall into, and work on fixing those areas.

Are the denials because of bad demo info? If so, make sure that whoever is entering the demo info has accurate/current information, and is entering it correctly.

Are the denials because of incorrect coding/billing? If so, educate the provider/biller/coder on their errors, to prevent further denials. Modifier usage, MUE, LCD, etc, all come into play with that education.

Regardless of why the denials are happening, as Michele said, work them as quickly as possible. In my office,  I rarely get denials. But when I do, they get corrected/worked and resubmitted same day.

What is your situation? Are you the in-house biller? Billing company? Something else? What sort of denials are you dealing with?

[CIA_2019]

I am working a backlog of denials for a client. These denials are mainly from medicaid, but some commercial denials. The services provided are PDN.
The denials are all over the place!

Are you familiar with these services? any tips on getting these type of services paid for Medicare and / or Medicaid?

[kristin]

PDN= Private Duty Nursing?  If so, I have zero experience with billing that type of service. However, I did some quick research for Medicaid and some commercial plans like UHC, and the requirements/information that needs to be on file with the insurance companies, etc., in order to have coverage provided for a PDN is quite extensive.

[CIA_2019]

Yes, Private Duty Nursing.  If possible, can you please direct me to some of the information that you found?

Thanks so much

[kristin]

Here is some info:

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/private-duty-nursing-services.pdf

https://medicaid.ncdhhs.gov/programs-and-services/long-term-care/private-duty-nursing-pdn

https://medicaid.ohio.gov/Provider/ProviderTypes/HomeHealthPrivateDutyNursing

There is a ton out there if you Google "billing PDN services"

[CIA_2019]

Thank you!

[medwave]

If you mean what is it you should provide your clients with, I'd say the following:

• Decrease client office overhead
• Support with operating and setting up Electronic Health Records (EHR) Medical Billing Software
• Utilizing online portals for electronic billing and health record management
• Submission of electronic and paper claims (Form-1500 02-12)
• Educating staff on medical billing and coding changes
• Training staff with online portal utilization and set up
• Obtaining Authorization for both in-network and out-of-network providers
• AR recovery management, Revenue Cycle Management
• Patient statements

[CIA_2019]

Thanks so much Medwave!