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10/3/2013
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experience reach //
CPAs & ADVISORS
TENNESSEE PRIMARY CARE ASSOCIATION ~ 2013 ANNUAL CONFERENCE
Thursday, October 24, 2013
CLOSING THE LANGUAGE GAP: PROVIDER-BILLER COMMUNICATION
ARE YOUR PHYSICIANS & BILLERS ON THE SAME PAGE?
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CHARACTERISTICS OF A BILLER
Street-level bureaucrat
Unscripted & unstructured environment
Utilize discretion
Adapt to circumstances
Problem-solving
Persistent
Responsible
Self-reliant
Emphasis on experience
Effective communicator
Performance-driven
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SKILLS OF A BILLER
Assembles all data concerning the bill
Charge entry
Claims transmission
Payment posting
Insurance follow-up
Patient follow-up
Regular communication with patients & payers to clarify billing or to obtain additional information
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SKILLS OF A BILLER, CONT.
Navigate through various insurance rules & regulations
Understand the nuances of various types of insurance carriers
Provide successful accounts receivable (A/R) follow-up efforts
Apply best practices for insurance & patient collections
Reduce risks by understanding collection practices, professional courtesy/customer service requirements, clean claims, timely filing guidelines, refund requirements
Use data & reports as indicators for potential improvement areas
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SKILLS OF A BILLER, CONT.
Understanding of codes
Current Procedural Terminology (CPT)
Healthcare Common Procedural Coding System (HCPCS)
International Classification of Diseases
• ICD-9 ICD-10
Different skills than a coder, but…
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CHARACTERISTICS OF A PROVIDER
Education
Highly educated in their field and/or specialty
Usually interested in advancing their understanding of the healthcare industry
Specifically interested in understanding outside factors that may impact them
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CHARACTERISTICS OF A PROVIDER, CONT.
Personality
All walks of life but share common traits such as:
• Want to do the right thing
• Analytical thinkers
• Usually collaborative
• Research, science & fact-based oriented
• Entrepreneurial
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CHARACTERISTICS OF A PROVIDER, CONT.
Interested in processes that:
Improve quality of patient care
Improve productivity
Improve patient satisfaction
Improve efficiency
Improve reimbursement & cut costs
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CAPITALIZING ON PHYSICIANS’ GENERAL CHARACTERISTICS
Competitive by nature
Like challenges
Desire perfection
Provide comparative date
Want to be right
Be mindful of their time
Just the facts
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WHAT WORKS WITH PROVIDERS?
Less is more
The devil is in the details
Access to an expert with the following in mind:
Why is this important ~ how can this affect me?
Focus training on physician’s unique role
Distinguish compliance from other administrative requirements or challenges
Do not make compliance the “bad guy”
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WHAT WORKS WITH PROVIDERS?
It’s about getting credit for the work that is done
If you are not part of the solution…
You are part of the problem
Have ready & implementable solutions
Provide useful advice
Acknowledge their concerns
Do not get into a debate
Do not defend the rationale for the rules
Help them comply!
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COMMON TYPES OF CONFLICT
People-focused vs. Issue-focused
Personal differences
Informational deficiencies
Role incompatibility
Environmental stress
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CAUSES OF CONFLICT
Different values & interests
Personality clashes
Scarce resources/budgets
Poor performance
Poor communication
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EFFECTS OF CONFLICT
Mis-communication resulting from confusion
Refusal to cooperate
Quality problems
Missed deadlines or delays
Increased stress
Decreased customer satisfaction
Distrust
Gossip
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NEGATIVE EFFECTS OF ORGANIZATIONAL CONFLICT
Decreases/destroys sensitivity
Causes staff to drop out or resign from positions
Arouses anger that disrupts work
Leaves “losers” resentful Inclines underdogs to
sabotage Provokes personal abuse Causes defensiveness
Diverts time & energy from the main issues
Delays decisions
Creates deadlocks
Drives unaggressive staff to the sidelines
Interferes with listening
Obstructs exploration of more alternatives
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METHODS TO ADDRESS CONFLICT
Accommodation: surrender one's own needs & wishes to accommodate the other party
Avoidance: avoid or postpone conflict by ignoring it, changing the subject, etc.
Collaboration: work together to find a mutually beneficial solution
Compromise: bring the problem into the open & have a third person present
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MEETING OF THE MINDS
How do providers & billers intersect within your organization?
How many here today are part of an organization in which providers & billers have ever had a meeting together?
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MEETING OF THE MINDS, CONT.
Have your organization providers & billers ever met together in order to review denials?
Misuse of modifiers
Review of payer policies
Understand the appeals process
Review medically not necessary diagnosis codes
Code to the highest level of specificity
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DIGGING DEEPER…
Are your billers afraid to talk to providers about documentation issues?
Do billers & providers instigate finger pointing?
Do they believe they are part of the same team?
Is it apparent they are motivated to working towards the good of all?
Are successes monitored? Shared?
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COMMON MISCONCEPTIONS & MENTALITIES
“It’s not my job!”
“I’m busy enough as it is!”
“It’s the physician’s fault, not mine!”
“What do they expect from me?!”
“The billers are probably writing everything off anyway.”
“The billers have no idea what I need to code to take care of my patients.”
“ICD-10 - I don’t need to worry about that until 2014. Besides, they will figure it out.”
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ARE WE SPEAKING THE SAME LANGUAGE?!
What are you really saying?
50-90% of communication is non-verbal
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WHAT IS YOUR ORGANIZATION’S COMMUNICATION PROCESS?
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VS.
WHAT IS YOUR FEEDBACK LOOP?
Communication methods
In person
Notes written on the chart and placed in stack of charts to review / Notes sent via Electronic Health Record (EHR)/Practice Management System (PMS)
Phone call
Key is to find something that works & stick with it – physicians like consistency
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EFFECTIVE COMMUNICATION TOOLS
Monthly or quarterly meetings between the physicians & billers
Discussions illustrating to physicians how vital it is they communicate with billers
Education about the billing processes and significant impact their role has on those processes
Regular financial reports with statistical data
Take time to get to know each other
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COMMON PITFALLS TO AVOID
Communication breakdown ~ no communication from the Billing Department when things are wrong
Typically not in a timely manner; usually after the issue has greatly compounded
Limited provider knowledge of billing functions
Provider education typically not geared towards billing mentality
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PITFALLS – INSTANT BRIDGE BURNERS
Generally, don’t start off conversations with:
In accordance with the law you must ....
The OIG said….
CMS Billing Manual citation….
Penalties under the False Claim Act are….
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BUILDING THE BRIDGES WITH PROVIDERS & BILLERS
Know their focus
Know their compliance risk
Know their characteristics
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KNOW YOUR AUDIENCE
What is their main focus?
Clean claims
Patient care & patient safety
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KNOW YOUR AUDIENCE, CONT.
Documentation problems
Billing for services
• Not documented
• Poorly documented
Up-coding and/or down-coding
Risk management issues
Incorrect reimbursement issues
Third party payer issues
Increased cost to correct mistakes
EHR/PMS issues
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What is their compliance risk?
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APPEAL TO THEIR INTERESTS
Demonstrate how documentation can:
Improve the quality of care & decrease safety risks
Improve overall productivity & efficiency
Improve patient satisfaction
Improve reimbursement & cut costs
Education
Provide examples relative to their specialty
Provide data from their specialty professional organization
Explain how this helps them to be in the top of their profession & how compliance impacts their specialty
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SUMMARY
Appeal to their interests to improve patient care
Appeal to their competitive nature
Understand how to phrase & tailor your discussions & educational efforts with physicians so each encounter is as effective & efficient as possible
Remember, the goal of most physicians is “the patient comes first”
Try to work compliance into their daily patient care routine
Above all, most physicians want to do the right thing!
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CONCLUSION
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QUESTIONS
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910 E. St. Louis St.
Springfield, MO 65801-1190
Monique D. Funkenbusch, CPC
Supervising Consultant
Office: 417.865.8701
Fax: 417.865.0682 www.bkd.com
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DISCLOSURE
Information contained in this presentation is informational only and is not intended to instruct hospitals and physicians on how to use or bill for health care procedures. Hospitals and physicians should consult with their respective insurers, including Medicare fiscal intermediaries and carriers, for specific information on proper coding and billing for health care procedures. Additional information may be available from physician specialty societies and hospital associations. Information contained in this presentation is not intended to cover all situations or all payers' rules and policies. Reimbursement laws, regulations, rules and policies are subject to change.
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