New Year Resolutions for the Medical Biller

By Ronald E. Nyman, Esq.

As the calendar has now turned to 2007, I am sure that many of you out there have made your New Year resolutions. I always like making resolutions, because I look at them as a way to set goals and apply the necessary focus toward achieving them. Goal setting, whether personal or professional, can motivate us and those around us.

With an eye to medical billing, there are several resolutions that you can make as we head into 2007:

1. Revise Superbill: One of the most important documents in your billing workflow is your superbill. As we all know, a good superbill contains the most commonly used CPT and ICD-9 codes in your practice. Unfortunately, in many practices, superbills contain deleted codes. If these codes are used to bill for a procedure, the claim will be denied. By carefully reviewing all codes on your superbill, you are forcing yourself to stay current on all coding updates affecting your practice. I have always believed that a superbill is akin to the foundation of a house. If it is accurate and complete, it will serve as solid underpinning for your billing department.

2. Review Fee Schedule: When is the last time you reviewed your fee schedule? I have asked this question of many practice managers, and I have heard answers from annually to never. If you are not reviewing your fee schedule on an annual basis, there is a good chance that your practice is losing money. On many occasions, the amount a practice charges for a procedure is below the maximum allowed by the carrier. Not surprisingly, when this is the case, the carrier gladly pays the lesser amount. So if a carrier will pay $80.00 for CPT 99214 and you bill only $70.00, the carrier will pay you $70.00. Thus, even though you collected 100% of the charge, you just lost $10.00!

There are many places where you can find helpful information when reviewing your fee schedule. Many look to the Medicare schedule and set their fees at a multiple of what Medicare pays for a particular procedure. For example, if Medicare pays $65.00 for a 99213, some practices will set their fees at twice that amount; in this case, $130.00.

Others, including myself, refer to Medical Fee Schedule guides which show varying fee percentiles for each code. These fee percentiles — 50%, 75%, and 90% — show what providers charge across a broad spectrum. For example, for 99201, the 50th percentile fee is $65.00, which means that 50% of doctors charge above this fee and 50% charge below it. The 75th percentile fee is $75.00, which means that 25% of doctors charge above and 75% charge below this amount. For practices where the providers participate in all major plans, it might make sense to set your fees in the 75th percentile as this ensures that you will never bill below the maximum reimbursement allowed by any particular carrier. Moreover, having your fees in this higher range does not adversely affect your patients because your providers participate with the major plans.

3. Attend Coding Classes: Okay, you have been telling yourself forever that you would attend all those coding classes that would help improve your practice reimbursement. However, you just have not had time to do it as each day’s work seems to run into the next. Just as Julie Andrews once said "Manners Matter," I would say, "Coding Counts." It is generally accepted these days that practices lose significant amounts of money due to inaccurate or incorrect coding. Coding seminars can help to address this problem by teaching you which codes to use in which situations and alerting you to any new coding changes on the horizon. For those of you who are really motivated, you might decide to become a Certified Coder. Organizations such as the American Academy of Professional Coders (AAPC) will provide certification to those who can pass its rigorous exam requirements.

I know that there are many other resolutions that you can make for the year but the above three are always tops on my list.

May you have a Happy and Prosperous New Year!

This article first appeared in the January 2007 issue of MediStar Meducation Alert^SM, the MediStar online newsletter.