Unbillable Services How To Get Paid

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  • Patient satisfaction
  • Unbillable Services How To Get Paid

    1. 1. Unbillable Services: How to Get Paid Presented by David J. Zetter, PHR, CHCC, CHCO, CPC, CPC-H, PCS, FCS, CHBC Pres ented by David J. Zetter, PHR, CHCC, CHCO, CPC, CPC-H, PCS, FCS, CHBC © 2011 Zetter HealthCare
    2. 2. <ul><li>No copyright claimed on government material or information. This material is designed to offer basic information. The information presented is based on the experience, training and interpretation of the author. Although the information has been carefully researched and reviewed for accuracy and completeness, neither the author, DecisionHealth or Part B News accept any responsibility or liability with regard to errors, omissions, misuse or misinterpretation. </li></ul>© 2011 Zetter HealthCare Disclaimer
    3. 3. <ul><li>Why you don’t get paid now </li></ul><ul><ul><li>(What are we doing wrong?) </li></ul></ul><ul><li>Unbillable services & common services that go unpaid </li></ul><ul><li>Be proactive vs. reactive </li></ul>© 2011 Zetter HealthCare Takeaways
    4. 4. <ul><li>Giving away services </li></ul><ul><li>Discounting services or non-collection of co-pays </li></ul><ul><li>Poor communications to patients </li></ul><ul><li>No financial responsibility policies </li></ul><ul><li>Poor planning and execution </li></ul><ul><li>Poor tracking & targeting </li></ul><ul><li>No processes & systems targeted to ensure payment… </li></ul>© 2011 Zetter HealthCare Why You Don’t Get Paid Now?
    5. 5. <ul><li>Do you communicate up front? </li></ul><ul><li>Copies of payer contracts </li></ul><ul><li>What isn’t covered </li></ul><ul><li>Requires practice wide buy-in </li></ul><ul><li>Involve everyone </li></ul><ul><li>Ensure accuracy </li></ul><ul><li>Processes & systems involved with getting paid… </li></ul>© 2011 Zetter HealthCare Why You Don’t Get Paid Now
    6. 6. <ul><li>Lack of astute & responsible staff </li></ul><ul><li>Lack of ownership attitude </li></ul><ul><li>Lack of payer familiarity </li></ul><ul><li>Lack of interest in the process </li></ul><ul><li>Lack of buy-in </li></ul><ul><li>Lack of “skin in the game” </li></ul>© 2011 Zetter HealthCare Why You Don’t Get Paid Now
    7. 7. <ul><li>Non Specialty Specific </li></ul><ul><ul><li>Medical record fees </li></ul></ul><ul><ul><li>Non-covered services </li></ul></ul><ul><ul><li>Disability forms </li></ul></ul><ul><ul><li>Insurance forms </li></ul></ul><ul><ul><li>No show fees </li></ul></ul><ul><ul><li>Patient balances </li></ul></ul><ul><ul><li>Routine services </li></ul></ul><ul><ul><li>Routine eye examinations </li></ul></ul>© 2011 Zetter HealthCare Unbillable Services
    8. 8. <ul><li>Non Specialty Specific </li></ul><ul><ul><li>DME </li></ul></ul><ul><ul><li>Physical therapy </li></ul></ul><ul><ul><li>Mental & nervous conditions </li></ul></ul><ul><ul><li>Alternative healthcare services </li></ul></ul><ul><ul><li>Services deemed cosmetic </li></ul></ul><ul><ul><li>Experimental procedures </li></ul></ul>© 2011 Zetter HealthCare Unbillable Services
    9. 9. <ul><li>Non Specialty Specific </li></ul><ul><ul><li>Some chiropractic services </li></ul></ul><ul><ul><li>Pre-existing conditions </li></ul></ul><ul><ul><li>Telephone calls </li></ul></ul><ul><ul><li>Email communications </li></ul></ul><ul><ul><li>Others </li></ul></ul>© 2011 Zetter HealthCare Unbillable Services
    10. 10. <ul><li>Podiatry </li></ul><ul><ul><li>Nail trimming </li></ul></ul><ul><ul><li>Routine foot care </li></ul></ul><ul><ul><li>Medical necessity issues </li></ul></ul><ul><ul><li>Other non-covered per patient’s policy </li></ul></ul>© 2011 Zetter HealthCare Unbillable Services
    11. 11. <ul><li>Pain Management </li></ul><ul><ul><li>Trigger point injections </li></ul></ul><ul><ul><li>Fluoroscopy and imaging guidance </li></ul></ul><ul><ul><li>Discography </li></ul></ul><ul><ul><li>Peripheral nerve injections </li></ul></ul><ul><ul><li>Percutaneous implantation of neurotransmitter </li></ul></ul>© 2011 Zetter HealthCare Unbillable Services
    12. 12. <ul><li>Dermatology </li></ul><ul><ul><li>Skin tags </li></ul></ul><ul><ul><li>Acne/laser surgery </li></ul></ul><ul><ul><li>Other cosmetic services </li></ul></ul>© 2011 Zetter HealthCare Unbillable Services
    13. 13. <ul><li>Family Practice/Internal Medicine </li></ul><ul><ul><li>Sports physicals </li></ul></ul><ul><ul><li>Disability forms </li></ul></ul><ul><ul><li>Insurance forms </li></ul></ul><ul><ul><li>Preventive visits in conjunction with E/M </li></ul></ul><ul><ul><li>Procedures billed with E/Ms </li></ul></ul>© 2011 Zetter HealthCare Unbillable Services
    14. 14. <ul><li>Orthopedics </li></ul><ul><ul><li>Athletic training evaluations </li></ul></ul><ul><ul><li>Sports medicine services </li></ul></ul>© 2011 Zetter HealthCare Unbillable Services
    15. 15. <ul><li>Physical Therapy </li></ul><ul><ul><li>Therapy caps (some payers) </li></ul></ul><ul><ul><li>Hot/Cold therapy </li></ul></ul><ul><ul><li>Authorization/utilization management </li></ul></ul>© 2011 Zetter HealthCare Unbillable Services
    16. 16. <ul><li>Other Specialties </li></ul><ul><ul><li>Non-billable services </li></ul></ul>© 2011 Zetter HealthCare Unbillable Services
    17. 17. <ul><li>Patients want to pay you? </li></ul><ul><li>Why? </li></ul><ul><li>Prevention is “best medicine” </li></ul><ul><li>Preventing “unbillable” services </li></ul><ul><li>Possible? </li></ul><ul><li>Thoughts on how to do it? </li></ul><ul><li>“ Aspire” to do better </li></ul>© 2011 Zetter HealthCare Be Proactive To “Win”
    18. 18. <ul><li>Operations manual </li></ul><ul><li>Processes & systems </li></ul><ul><li>Documentation </li></ul><ul><li>Detailed consistent training </li></ul><ul><li>No room for error </li></ul>© 2011 Zetter HealthCare Be Proactive To “Win”
    19. 19. <ul><li>Hire & train astute staff </li></ul><ul><li>At time of service </li></ul><ul><ul><li>Appreciation </li></ul></ul><ul><ul><li>Insurance confirmation & benefits summary, including unmet deductible </li></ul></ul><ul><ul><li>Explanation of benefits </li></ul></ul><ul><ul><li>Financial policies </li></ul></ul>© 2011 Zetter HealthCare Be Proactive To “Win”
    20. 20. <ul><li>Hire & train astute staff </li></ul><ul><li>At time of service </li></ul><ul><ul><li>ABNs </li></ul></ul><ul><ul><li>Options to pay </li></ul></ul><ul><ul><li>Financial advocate </li></ul></ul><ul><ul><li>Price Estimation </li></ul></ul><ul><ul><li>Patient statements </li></ul></ul>© 2011 Zetter HealthCare Be Proactive To “Win”
    21. 21. <ul><li>“ How will you be paying today” </li></ul><ul><li>Collecting a balance </li></ul><ul><ul><li>Mr. Steele, our practice’s policy is to request payment at the time of service. Your insurance plan requires a copayment of $____. Will you be paying with cash, check or credit card? I also noticed that you have a balance of $____. Can we go ahead and take care of that on your card today as well? </li></ul></ul>© 2011 Zetter HealthCare Be Proactive To “Win”
    22. 22. <ul><li>Addressing concerns about your “new” policy </li></ul><ul><ul><li>Mr. Steele, I understand your concern, but our office procedure has changed because of rising costs. Paying at the time of service keeps our administrative costs from going higher so we do not have to charge more for our services. It also lets you take care of your payment now instead of waiting for a bill. Would you like to pay by cash, check or credit card. </li></ul></ul>© 2011 Zetter HealthCare Be Proactive To “Win”
    23. 23. <ul><li>Frustration at payment </li></ul><ul><ul><li>“ Mr. Steele, our first concern is your care. Getting payment for that care ensures that we can continue providing quality treatment that you and our other patients expect. Would you like to pay by cash, check or credit card” </li></ul></ul>© 2011 Zetter HealthCare Be Proactive To “Win”
    24. 24. <ul><li>Know your payers & contracts </li></ul><ul><li>Processing demographics </li></ul><ul><li>Communicate financial policy & obtain understanding and signature </li></ul><ul><li>ABNs & capturing every charge accurately </li></ul><ul><li>Determine patient responsibility and collecting </li></ul>© 2011 Zetter HealthCare Steps to Getting Paid
    25. 25. <ul><li>Communicate with patient </li></ul><ul><li>Address concerns </li></ul><ul><li>Patient payment/deferred payment </li></ul><ul><li>Learn from every patient </li></ul><ul><li>Learn from every procedure </li></ul>© 2011 Zetter HealthCare Steps to Getting Paid
    26. 26. <ul><li>Adjudicate accounts </li></ul><ul><li>Monitor performance </li></ul><ul><li>Revise financial policies, systems & procedures </li></ul><ul><li>Receive & post payments </li></ul><ul><li>Make your deposit! </li></ul>© 2011 Zetter HealthCare Steps to Getting Paid
    27. 27. <ul><li>For Follow-up & Further Questions </li></ul><ul><li>Contact: </li></ul><ul><li>David J. Zetter, </li></ul><ul><li>PHR, CHCC, CHCO, CPC, CPC-H, PCS, FCS, CHBC </li></ul><ul><li>717.691.7100 </li></ul><ul><li>Email: djzetter@zetter.com </li></ul><ul><li>Web: www.zetter.com </li></ul><ul><li>Twitter: www.twitter.com/djzetter </li></ul>© 2011 Zetter HealthCare

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