Are your payer contracts set up correctly?
Problem : Services delivered from a home infusion company are priced and billed based on the products delivered and how they are set up in the inventory and payer/contract files. The problem is, these files are not always set up correctly or in synch with one another. The end result is a lot of manual manipulations in the billing process, inaccurate billing and denied claims.
Cause: These three areas; inventory, payer / contracts and service delivery are handled by three different areas of an organization. When new inventory items are added, for example, the other areas of the business need to adjust the set up of their files accordingly. When AWP pricing is updated from Medispan or First DataBank, the changes need to be reviewed to make sure pricing is still correct. When prescriptions, equipment and supplies are delivered to the patients, it is important that they are done so in a manner consistent with the payer billing requirements.
Impact: The impact of the errors caused ranges from under priced claims to denied claims that delay payment. In addition, many companies require their billing staff to spend extensive time auditing claims for accuracy and change them prior to sending to the payer. Often the problems found are fixed for the claim but not in the prescription or inventory/payer pricing set up to avoid recurrence.
Solution: Using a report writer or Home Infusion Reports from Rock-Pond, print a report of your payer contracts that lists out all of the options selected to quickly review them to find errors and omissions. Compare the payer setup with the hard copy files. Secondly, using a report writer or Home Infusion Reports, create a report of all new / changed inventory items for your payer/contract management staff to review each time a new item is added or changed.
Benefit: With automated processes in place, you will be able to catch billing errors before they occur and improve the effectiveness of your billing staff.