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Provider Type
Cardiology Clinic
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Location
Florida
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Services
Billing,Coding,Collections,
Florida-based cardiology clinic achieves a 65% decrease in 30+ AR days and an 85% decrease in 120+ AR days.
Find out how the AR team at AIMA helped our client improve their accounts receivable processes. See how they benefitted from cleaner claims and speedier reimbursement. Learn how your healthcare business can improve your cash flow and get you paid quicker.
AR Services from AIMA
An intelligent, well-implemented accounts receivable strategy is vital to successful revenue cycle management. Your dedicated AIMA team harness years of experience with proven best-practice methods to collect the payments owed to you. We reduce Accounts Receivable backlogs by identifying the problems and implementing long-term solutions.
Days in AR are key performance indicators that drive any medical-related practice or organization’s success. AR days measures the amount of time it takes to receive payment on a claim. According to industry benchmarks, AR days for can range between 30 and 60 days.
Scenerio
Central Florida-based cardiology and vascular clinic had built up a vast aging balance. Their previous billing company had allowed significant medical coding, billing and authorization issues to mount up, resulting in a troubling scenario for the clinic of 30+ AR days of over $475k and 120+ AR days close to $300k.
Solution
AIMA began working with the cardiovascular specialists in March 2020, achieving almost immediate improvements in their claims and reimbursement results. Our priority was to appoint a dedicated AR team of RCM professionals with experience in clearing historical aging debt.
The AIMA team identified several significant issues with their coding, billing and authorization processes causing the worrying large aging balance:
- Non-Collectable Dead AR
- Billing Errors
- Coding Errors
- Eligibility Errors
- Authorization & Referral Errors
- Pending for MR & In-process
- Current denials & incorrect denials
Result
Since working with our dedicated AR team the cardiology clinic clean claims and reimbursement results have improved significantly.
65% decrease in 30+ AR to $167k
85% decrease in 120+ AR to below $50k
Issues Faced
- MISSING THE CODES
Incorrect/incomplete codes entered and billed. - HIGH CLAIM BILLING LAG
Claim billing lag over ten days from the DOS. - DOS MISSED TO BILL
Several
DOS/appointments not billed without a specific reason. - CPTS BILLED WITH NO CHARGE AMOUNT
Incorrect settings in the PMS. Many CPTs billed with zero charge amount. - CPTS BILLED WITH INCORRECT CHARGE
Many CPTs billed less than the allowed amount by the payer. - CLAIMS BILLED TO WRONG PAYERS
Claims billed to incorrect payers, for instance, Medicare instead of Medicare HMO or billed to secondary instead of primary. - CLAIMS BILLED WITH MISSING/INVALID AUTHORIZATION
Claims billed without required authorizations or entered with incorrect auth/reference. - INADEQUATE CODES BILLED
E&M, testing and procedural codes incorrectly billed, resulting in denied or underpaid claims. - INCORRECT/MISSING MODIFIERS
The previous biller did not append the correct modifier or failed to use modifiers when required. - GLOBAL PROCEDURES BILLED
Procedures billed without checking the global periods. - INCORRECT DOCUMENTATION
Incorrect and incomplete chart documentation identified during payers during audit resulting in a penalty. - INCORRECT UNITS
Codes billed with incorrect units exceeding maximum allowable units. - MEDICAL NECESSITY NOT CHECKED
Incorrect usage of ICD/CPT combination and not checking the medical necessity and claims denied for incorrect NCD/LCD guidelines. - PAYER GUIDELINES NOT FOLLOWED
Payer guidelines not followed on coding. For instance, Medicare, Medicaid, and Medicare/Medicaid replacement payers have specific guidelines on coding. - BILLED WITH INCORRECT POLICY NUMBERS
Policy number not verified before billing. - AUTHORIZATION NOT OBTAINED
Authorization or referrals not received before services resulting in many claim denials. - AUTHORIZATIONS/REFERRALS NOT UPDATED
Authorizations or referrals not correctly updated in the system, resulting in claims billed with expired authorities. - CLAIM PENDED FOR ADDITIONAL DOCUMENTATIONS
Claims denied/pended for additional documentation without address resulting in non-payment. - ERAS NOT RECEIVED
Claims paid on time without obtaining EOBs or ERAs on time to post the payment in the system. - SECONDARY DENIED AS PRIMARY PAID MAX
When secondary claims get denied due to the primary claim paid more than the secondary allowable amount, the balance should be written off with the provider’s consent. Balances not addressed and sat in the AR bucket for a long time, increasing the aging balance. - NON-COVERED CHARGES AS PER PROVIDER PLAN
Claims denied as non-covered as per provider contract and no contract with the payer.
AIMA Action
- Pre-billing audit to summarize the billable codes for DOS and pick correct codes to bill.
- 24-48 hours turnaround time on coding/billing from the DOS. We reduce the billing lag to a maximum of three days.
- Reconciliation of appointments before billing. Summarize the billable appointments and send routine exceptions avoids any missed billing.
- Reconfiguration of all fee schedules and set standard billed amounts for all the CPTs in the system.
- Establish standard fee schedules as per the provider’s requirement. Set the billed amount as 1.5 times Medicare allowable across the system.
- Implement verification reports to identify the right payers to bill on DOS.
- Post-billing audit to identify any vital info omitted in the claim. Scrubbing rules in the clearinghouse portal to avoid further rejections or denials.
- Pre-billing audit of all chart notes, procedure notes and test results. We identify the correct codes as per the provider documentation.
- Coding audit to identify the requirement of modifiers on E&M codes and distinct procedures and append the correct modifiers for better reimbursement.
- Reduce the volume of denials from payers by appending the correct post-op modifiers once a consultation or procedure is complete during the post-op period. Claims not covered as per the post-op coding guidelines are written off with provider approval.
- Streamlined process to create clean coding/billing practices and meet payer audit requirements. Daily check of provider documentation and advise providers on any incomplete/missing/unsigned notes in the system.
- Coding audit to identify and fix incorrect unit cases.
- Once consult/procedure is complete, the new method identifies the proper LCD/NCD guidelines for correct billing.
- Correct coding protocols followed as per each guideline to increase reimbursement and reduce denials.
- Pre-verification of eligibility and benefits. Any changes in the eligibility/policy/plans identified before the appointment date and communicated to the front office or patient accordingly.
- Pre-verification and
Authorization processes to request referrals from PCPs. Completed in advance to allow sufficient time to follow up on the status of authorization or referrals to ensure all information in place before seeing a patient. - Authorization and follow up process to update the information accordingly and
identify expired authorization/referrals to eliminate denials. - Tracking denials and correspondence with denial management within 24-48 hours of receipt.
- Electronic claim and payment transactions to save time and speeds up reimbursement. Practice enrolled for EFT/ERA with maximum payers. 95% of payments now deposited through EFT, and payment explanation loaded via ERA directly into the system. Payments posted on time and payment lag reduced.
- Monthly review of non-collectable denials and writing off upon provider approval.
- Credentialing and contracting processes with new payers, communicated to the front team or patient on non-accepting payers/policies.
Introduction of billing reconciliation, pre-verification, authorization and billing turnaround resulted in TFL-related and authority-related claims reduced.
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