The past few decades have seen a lot of changes in billing for anesthesiology. Among the changes are advancements in software like front-end claims scrubbing, front-end meaning prior to AR. Claims scrubbing is undoubtedly a “no brainer” method in optimizing the billing process. Savvy anesthesia practices need to be wary of billing companies that rely too heavily on the capabilities of their front-end scrubbing. Many billing companies believe the only way to ensure accurate, on-time coding and billing for every patient and carrier is to remove the element of human error altogether and automate the process. As a result, staff is drastically reduced and many state 100% of their claims are submitted clean.  The billing company benefits by being able to greatly reduce their internal staffing needs and in return the anesthesia practice receives billing services at a very attractive price. It’s a win-win right? It may appear so at first but let’s take a closer look.

Front-end Scrubbing = Clean Claims

The point of claim scrubbing is to get claims cleanly through the system to the insurance carrier. The claim scrubber software edits daily charge batches against carrier rules. Proper claim scrubbing increases the likelihood for first time payment, validates 837 files for the carrier, identifies potential problems and errors on claims, and ensures HIPAA compliance for all claims. A “clean” claim is a claim that satisfies all the rules and requirements of a particular carrier. The initial investment for front-end claims scrubbing software quickly pays for itself as denials are decreased.  The overall result for the anesthesia practice is a quicker cash turnaround and who doesn’t want that!

Room for Error Means Room for Denials

So now that the billing company has demonstrated to your practice that they’ve submitted 100% clean claims and you’ve likely seen an improvement in your cash flow, what’s next? While it may be factual that all their claims are submitted 100% clean, that doesn’t guarantee there won’t be denials. Let’s start by considering the volume of data contained in a single billing claim including; patient, insurance, coding and physician information. Add in the ever-changing healthcare industry we live in and the complexity of anesthesia billing in comparison to other specialties. There is tremendous room for error and there is tremendous room for denials.

When Clean Claim Denials Occur

How can a clean claim be denied? There can be lots of reasons. For the purpose of this article let’s focus on what will take place when a denial occurs. After all, you received that attractive price for services in part because the billing company was automated and taking care of all your claims up-front. Now that automation has only taken your practice so far, aren’t you curious how their downsized staff will be able to respond? A billing company may take this opportunity to tell you it’s such a small percentage that it’s irrelevant to the big revenue picture.  It’s true the remaining balances will be irrelevant to them. The costs required for follow up would hurt their bottom line. So they run reports and flash some numbers up to show the benefit of a low billing cost out weighs the loss in revenue. Our clients own experiences with other billing companies in comparison to abeo, will tell you that is simply not the case. That missing revenue makes all the difference to our clients’ success.

It’s important you understand the entire process 1) the capabilities and how the software works, and 2) who is responsible for carrier follow up when a denial takes place.

How Claim Scrubbing Software Works

Understanding how the software works will require you to dig. Here are some important questions to ask your current or prospective billing company about their claims scrubbing software capabilities.

  • Does the software merely check for a field to be complete or is it checking for accuracy too?
  • How are batches released into the software?
  • What is their process for receiving and adjusting their scrubber with updates to carrier-based rules?
  • Do they have the ability to build their own rules within their claims scrubber solution?
  • Who is involved in the maintenance of the software and hardware needed to run the scrubbing solution? Is it in-house or a third party they are depending on?
  • What sort of adjustments have they made to their front-end scrubbing software over time?
  • How does their software trigger alerts when a problem is discovered?

Who Will Follow Up on Unpaid Claims

Next, you want to clearly understand who will be working the back-end. You should know who will be following up on alerts or concerns that might take place during the front-end scrubbing and who will follow up with carriers when a denial occurs.

  • Do you have a dedicated client manager that will report to you and oversee follow up?
  • If yes, how large is their billing support staff and are they located here in the U.S.?
  • Are there processes for checks and balances in place? Who reviews it?
  • What are the carrier trends they are seeing and how are they interacting with carriers to address those trends?
  • What type of reporting do they provide?
  • Take it a step further and explore the processes and methods in place for patient follow up? Does their reduced staff have the means to tackle both carrier and patient follow up?

Effective billing software requires time, energy, updates and maintenance. Effective billing practices require time, energy, training and human intervention. abeo leverages the power of front-end claims scrubbing but is careful not to discount the importance of human intervention. There are errors and occurrences that computer software cannot analyze and determine the best response or action that needs to occur for your particular anesthesia practice. Too many anesthesia practices just hope for the best or believe the cost of a higher billing fee won’t outweigh any inefficiency or revenue loss that occurs in an all automated approach.

 

 

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