improving a tpl billing system john greenawalt, lpc director of quality management terros april 12,...
TRANSCRIPT
Improving a TPL Billing System
John Greenawalt, LPC
Director of Quality Management
TERROS
April 12, 2011
Tip #1
Find out where you are: Are you billing all the services you are providing?
How do you know??? A non-billed report
• Based on the electronic schedule• Or on Super bills, if you are still paper based
Follow some services through your system Check to see that services are flipped to the secondary
insurance once payment is made by the primary.
Tip #2
Ensure that your receipts entered into the system
EOB’s are carefully entered Client balances are adjusted
Insurance adjustments Co-pays Write-offs
• (in case you provided a service that is not covered by the TPL)
Follow a payment through your system.
Tip #3
Track your authorizations Questions:
Who gets them? Where are they posted? Who keeps track of them?
At TERROS: coordinate between front office and clinical
Clear communication between front office, clinical and billing staff
Tip #4
Track your denials These will probably lead to a few common issues that
may be improved with training /supervision For instance:
Not a covered service Wrong provider provided the service (not in the
authorization) Authorization was expired Authorization was never requested
Tip #5What you need to Find Out
What part, exactly, does each staff play regarding billing & collections? Appointment staff Front office staff Clinical staff Medical providers
Work up a detailed process flow-chart for each staffing group Find out how each group touches an aspect of the
production / billing / collections systems Find out where the cracks are Fill the gaps – work with the staff who do the job
Tip #6
Improve communication: Between:
Intake and billing Billing and front office Front office and appointments (call center at TERROS) Don’t forget clinical and medical providers!
TERROS developed the “TPL Information Sheet” A structured monthly meeting with members of each
group can be very helpful to ID billing and collection gaps and barriers
Tip #7Utilize Technology
Insurance company web portals Instant and up to date information
Internal Reports Need real time data to be helpful
External data dumps EOB’s sent electronically to your system, with auto
updates of all accounts
Graph your successes Watch those lines go up the chart!
Share the information
More on Internal Reports
Reports: Are able to be run by clinician, by site, by TPL in order
to ID where the problems are Can track aging by TPL and by claim Will detail the ‘denials’ and allow billing staff to make
corrections, and re-bill Will lead you to common errors, that may be fixed by
training and supervision
Tip #8Payments may come 60-150 days after service
provision
Charges are posted on the front end, but payments are usually posted on the back end, so your chart will need some explaining
You can calculate actual percentages of dollars received ($50 collected out of $100 billed = 50%)
Or you can also calculate the ‘expected’ percentage of dollars received ($100 billed, but only $80 is collectible: $50 collected = 63%)
A Bit of Progress
When TERROS started this, we were noting a TPL collection rate of 14%
Today, we are noting a collection rate of 70%, of collectible
There is still more work to do.
Any Questions?
John Greenawalt - [email protected] Green - [email protected] to NIATx Billing Guide -
http://www.niatx.net/Action/PromisingPractices.aspx
Link to ACTION Campaign II Webinar Library – http://www.niatx.net/Action/WebinarLibrary.aspx
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