There are a few things you can look for to determine if your billing company is not maximizing your revenue.
Hint 1: Does your current company reconcile every payment versus the contracted rates on a line-by-line basis?
Ask your current company for the line-by-line reconciliation for the past 6 months of billing for your anesthesiology department. If it doesn’t exist or doesn’t show that a significant percentage of the claims were kicked back, then you are being short changed by your payors. Here’s why –
Its impractical to do for most general medical billing companies, but a very important part of anesthesiology billing. Most billing companies reconcile at the macro level, shrug off what appear to be minor discrepancies, and move on. The problem is, healthcare costs tend to go up rapidly. So if payors are paying based on outdated data, they will measurably underpay their contracted obligations.
Your anesthesia billing company should be cross-checking every line item of every claim to ensure that it meets the contracted rate with that specific payor. If there’s a discrepancy, it should be automatically kicked back to the payor to ensure you are receiving the contracted rate.
Hint 2: Does your current company provide customized real-time reporting?
Ask your billing company to provide you reports that show reimbursement rates, expected cash flow for the month, collected vs expected, days in accounts receivable, year-to-date revenue comparisons and provider comparisons. If they don’t have them, that means your billing company isn’t looking at them, which means they aren’t doing their job of maximizing your collections. Accurate reporting and total transparency should be critical for any billing company that you do business with.
Hint 3: Does your billing company brag about low days in accounts receivable?
We see billing companies talk about how they focus on keeping accounts receivable low. Days in accounts receivable is the average time from performing services to receiving payments. Generally speaking, lower is better. It’s obviously important to get paid promptly, but when it comes to anesthesiology billing, an accounts receivable lower than 30 days often indicates that the billing company is just accepting whatever the payors send, and writing off the rest. That’s great for the billing company, but bad for the anesthesia providers.
Maximizing revenue means looking at every line item and ensuring it meets the contracted amount for that service. It means arguing with payors to overcome bogus claims and disputes to force them to meet their obligations. If a payor tries to reject or discount a valid claim, your billing company should be fighting with them over it. That takes time.
Your billing company’s goal should be how to maximize your revenue, not keeping days in accounts receivable below an arbitrary number.
Did you know….The easiest way to determine if your anesthesia practice is collecting less than it should be is to ask Fusion Anesthesia for a no obligation 6-month billing audit. We will show you exactly where you are losing revenue, and how much extra revenue you could be collecting.
General Anesthesia Billing Questions