IOP and PHP BILLING
IOP and PHP BILLING
Infallibill understands Pediatric Billing because we have coders who use to work for Pediatricians for years before coming to us.
In the 21 years that Infallibill’s coders have been working with Behavioral Health Companies we have noticed two things primarily are the main reasons that behavioral health groups receive less than ideal reimbursements:
1. Lack of Process and Documentation
2. Improper use of Billing codes and Lack of followup
So just how does Team Infallibill fix this
1. Patient Check-in
Patients should be checked in with a checklist approach! Starting with the VOB all the way through Utilization Review and when finally seen by a practitioner all pertinent details should be thoroughly noted starting with, demographic information as well as information about his/her situational position, pertinent insurance details, just having the insurance payer and policy number is not enough now days, criteria questions and employment questions should be added to checklists, remember now is the time to get this info as later on this info may be harder to acquire. All info that will be and can be used or is ultimately mandatory in claim situations should be gathered at the time the patient is checking in.
2. Insurance Eligibility and Verification
Just because an insurance providers plan looks good online or looked good last year does not mean that this policy still pays out at the daily rate it should or did. It helps to have archives of EOB data which all medical practices should be regularly categorizing and should have been categorizing all along. If not this is not the end of the world, obviously that is why we are TEAMING up we help with the foresight and can help you navigate through this complex system of changes and chaos. After working with some of the largest Drug and Alcohol treatment centers in the industry we know a thing or two about what could be and what actually is.
3. Medical Coding and Modifiers
This is where our team comes in. Proper coding of claims is the key ingredient to communicate to the insurance providers of what the patient is actually being treated for and the modality of the actual treatment they are receiving via diagnosis codes that break down the actual symptoms, dependencies or illnesses and the correct procedure codes to describe the facilities methods they will use to treat. If these codes are off due to negligence or 9 times out of 10 laziness, then the CPT and HCPCS code modifiers will not match up to the information about the service or procedure performed. The Insurance Provider groups can only make an accurate assessment if they have the correct codes and modifiers, as they receive millions of claims per year and without automation would be lost in a world of chaos. Coding is not as simple as it once was for mental and behavioral health, with the amount of groups out there submitting false and fraudulent claims like in 2017 over 19.4 billion dollars worth of deficit losses to Insurance carrier companies they are only going to get smarter and tighter on their reviewing of claims and holding of capital to produce payouts. Team up with Infallibill for your treatment center billing needs and escape the clawback situations that are just around the corner.
4. Charge Entry
Number one mistake made from billers and coders as well as at the checkin side of the facility. And this could cost millions… We have built a if this then that sequence that will not allow our employees and hopefully yours to make mistakes like this so we can save while others are loosing.
5. Claims Submission
Without having built long lasting relationships with all the major providers over the last 21 years it would be impossible to understand the flow and rapid response needed to be able to fastrack this process and still keep a finger on the pulse with repeatable excellence. Submitting claims is not textbook and every provider is different. All the portals are different in fact knowing when and how to use their portals is a protocol that is learned through conversations not through trial and error. Some carriers actual have multiple portals for different policies. Do not let your “new to the market” billing group use you as their trial and error beta test version trust the Infallibill Team to bypass all the drama.
Most insurance providers follow a standard set of guidelines for billing, however many of the payers do not. Most medical billing algorithims are payer-specific, so it is imperative to align and communicate with all payers to make sure that you are actually adhering to their specific rules of engagement for each claim that is submitted.
6. Payment Posting
Posting and deposit documentation is important especially to cut down time spent by employees and or your agencies on the phone with extremely mad clients. Checks and balances prove what has been paid by the providers and what is owed or settled by the clients. This allows simple math to be demonstrated to all parties in which transactions are the important aspect of the business primarily, The practice, the patients and the practices accountants. By this point the Insurance providers have settled and removed themselves from the equation in their mind. This is the last thing that causes problems in collections for the practice and can be avoided with proper systems in place which Team Infallibill can put into practice before it is too late.