4 Tips to Ensure an Accurate and Timely Billing/Charge Entry Process
To ensure an accurate and timely billing process between billers and physician officers, your ASC should embrace the following best practices:
Intimate knowledge of pay regulations and modifier usage
Billers must not only understand state and federal billing regulations such as bundling and unbundling, but specific payer regulations as well. Payer regulations include the use of billing modifiers. For example, a federal plan may call for a modifier LT (left side) and RT (right side) for a bilateral procedure while a commercial payer calls for a modifier 50. If the wrong variation is used, it can hold up the billing process, delay payment or decrease the reimbursement.
Timeliness when posting billing charges
It is essential for billers to post charges as soon as they are received from the coders. In better performing centers, there is no difference between the charge entry lag (DOS to charge entry) and the billing lag (DOS to claim submission). Charges are dropped at a minimum of once daily, sometimes twice. Waiting for a sufficient amount of claims prior to sending will slow down the claim process and add unnecessary days to a facility’s A/R Days.
Using a robust clearinghouse designed for your specific industry
In order to ensure an accurate and timely billing process, a robust, industry specific clearinghouse, which reports and analyzes claim denials, should be utilized. The biller can use this denial data to set up specific rules within the clearinghouse to “scrub” claims prior to being sent to the payer. These “edits” should be worked within 24 hours creating a process where only clean claims are being sent to the payer. A good rule of thumb is it’s better to take an extra day to ensure a claim is clean then to wait 30 days for a claim to be denied.
Billers often need operative reports, implant invoices and the history and physical of the patient from the facility and/or physician offices in order to proceed with claim submissions. Establishing a good communication line between a biller and the physician office and facility may help prevent any lag in the claim submission process.