Specialized Billing Issues
Patient billing has become one of the most difficult and complicated processes
in the
operation of the hospital. It seems like changes are occurring almost
daily. It is
extremely difficult to stay 'ahead of the curve' on issues that effect the
very lifeblood
of the hospital. One of these issues is the group appeal that we have
initiated regarding
Outliers. This issue alone is and will be a major focus of our attention
over the next few
months. Other specialized billing issues such as proper treatment of blood
deductibles and
other items have generated additional reimbursement for our clients, as
well. Blood has
been a very confusing and frustrating issue for patient accounting
professionals since
1966 and it hasn't changed much in the interim. In addition, there are
other issues that
arise as your patient mix changes between traditional carriers and managed
care providers.
Benchmark
: If you have blood deductibles on your Medicare or
other payor bills, if you experienced a growth in Medicare managed care
activity, if you
have swings in your outlier totals, or any other unusual variances in your
revenue/receivable management process, you may need this area reviewed.