Timely & Accurate Reimbursements for Wound Care Practice

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Timely Accurate Reimbursements for Wound Care
Practice
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Timely Accurate Reimbursements for Wound Care
Practice
Major challenge in successfully running wound
care practice is receiving timely and accurate
insurance reimbursements. Medical practices can
efficiently manage overheads if they receive
accurate insurance reimbursements on time. One of
the key factor in receiving reimbursements for
wound care practice is understanding payer
requirements. If they are not known/met you are
significantly increasing the chance the claim
will be rejected (have an administrative or
clinical error) or denied (deemed unpayable),
resulting in extra office processing costs of
2565 or more per claim. Another challenge is
understanding write-offs. If you accept
assignment, the difference between the billed and
allowed amount is the write-off. Write-offs that
physicians, especially those in private practice,
need to focus on are those due to patients not
paying, as well as write-offs due to a denied or
rejected claim not being reprocessed, as these
are draining revenue from the practice and
reflect revenue the office can control. In this
article, we discussed other factors that affect
timely and accurate reimbursements for wound care
practice. Factors Affecting Timely Accurate
Reimbursements for Wound Care Practice Insurance
Payer Requirements Understanding payer
requirements is essential step in receiving
timely and accurate reimbursements for wound care
practice. Revenue cycle activities include
scheduling, staff responsibilities, medical
record documentation, charge capture, coding,
charge entry, claims transmission, payment
posting, denial management and working accounts
receivable. Out of all these RCM activities you
need to highlight activities that require
modifications as per payer requirements. Primary
focus must to understand payer medical
necessity/clinical requirements for the test,
procedure, service or care.
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Timely Accurate Reimbursements for Wound Care
Practice
Fortunately, major insurance payers have medical
necessity and clinical documentation requirements
available to you. This information is to be found
on the payer websites under names such as
clinical policies or clinical bulletins. Aligning
Office Processes The best way to determine where
revenue is being lost, excluding write-offs is to
generate a report indicating what services result
in a high volume of claim rejections or are
denied. If you outsource billing services and
your office is not capable of generating current
claim status reports without help from the
outsourced billing provider, there is a lack of
transparency and a new billing service needs to
be used. Based on the reports, you might focus on
high-value services, lower-value services that
have a high percentage of claims rejected/denied
or you might just start with addressing the
insurance payer that results in the most revenue
being rejected/denied. Your office needs to be
proactive so they can meet or support payer
requirements. You know where medical necessity
and clinical requirements can be found, but do
the physician/clinical staff have a template or
checklist that will help them to obtain and
document that critical information? Within 48
hours of the appointment being made, does the
physician briefly look at the reason for visit
and indicate test, procedures and services the
patient will likely need? If so, administrative
staff can begin work on obtaining prior
certification. Start by maybe doing this with
five established patients a day with a goal of
doing this for all patients.
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Timely Accurate Reimbursements for Wound Care
Practice

• Some of the administrative activities that will
  help to receive timely accurate reimbursements
  for wound care practice are
• Performing 100 percent patient eligibility and
  benefits checks
• Ensure every test, service or procedure that is
  rendered is documented and that the charge
  capture sheet is current
• Have a backup plan in place so when primary
  coder(s) are absent, coding can still be done
  without delaying the generation of revenue
• Services rendered need to be input on the claims
  forms with minimal delay, within 24 hours of
  receipt
• Electronic claims should be sent multiple times
  throughout the day and paper claims need to be
  sent daily
• Payment posting should include the processing of
  all payments within 24 hours of receipt
• Promptly distributing for rework all
  rejected/denied claims, as well as those that
  were underpayments
• Verifying claims were received, checking on the
  status of claims (within two days of the date
  that the claim should have been processed).
• Legion Healthcare Solutions is a leading medical
  billing company providing complete billing and
  coding services. We can assist you in receiving
  timely accurate reimbursements for your wound
  care practice. With our assistance in medical
  billing and coding, you can focus on prime
  function of your practice i.e., patient care. To
  know more about our wound care services, contact
  us at 727-475-1834 or email us at
  info_at_legionhealthcaresolutions.com

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