Have you ever heard the phrase “necessary evil”? I like to research phrases and terms to find the root of their usage and how they came to be. I didn’t have much luck with this one. The best I could do was it is the name of the B-29 Superfortress airplane that was used in the 1945 atomic bomb attack on Hiroshima. I thought that was a very poignant way of getting a point across. It captures the distress of what they knew they were doing, yet it was something that at the time they felt is was quite necessary to end further destruction.
When I think of necessary evils, I think of things like traffic lights, Medicare and television, not necessarily in that order. I know we need traffic lights but every time I am in a hurry or running late for an appointment I end up getting caught up in the red light traps, and I am certain that traffic lights are a tool of the devil designed to make me late. As for certain television shows anything outside of the news is a bit difficult to stomach these days. Even the children’s programming is a bit difficult to handle these days. How many times a day can you watch a purple dinosaur singing about his feelings for you. I digress, the reason we are here is to discuss essential billing tips. In order to bill it is necessary to receive the appropriate documentation, and that brings me to my last “necessary evil”.
Certificates of Medical Necessity (CMNs) and Physician Orders (POs) are not only an important aspect in the billing process, but quite possibly the most frustrating. A company’s account’s receivable can increase due to the number of claims waiting for this documentation in order to be billed. One of the best ways to gain a complete CMN and PO, is to train your intake staff.
Your organization’s intake staff must be trained on the coverage criteria on the variety of medical equipment they dispense. For new employees, start this training at the time of orientation. Develop cheat sheets with the information required and organize them in a binder separated by equipment category or you can copy the Medicare Medical Policy for all equipment which requires a CMN or specific detailed information on the Physician Order (i.e., surgical dressings). This coverage criteria is also important when the patient is only allowed a certain number of supplies per month and when a prior authorization is required. Intake personnel must also be aware of the Medicare requirements regarding dispensing orders and written orders prior to delivery (WOPD).
In order to assist your intake personnel in learning, make them correct their own mistakes. If they are missing information, then they must get it. It is not the responsibility of the billing department to go after information that was to be retrieved by customer service. Mistakes at intake lead to mistakes in the CMN and billing process, which leads to claim denials and hold up and ultimately results in increased AR.
It is helpful to designate a specific person in charge of processing CMNs and physician orders within the billing department. This person, along with the other billers, must have knowledge in the coverage criteria set forth by Medicare in their Medical Policy chapter and they must know the regulations on completing the CMN. If the medical documentation is not returned in a timely fashion, then the company’s accounts receivable will increase due to the revenue that is waiting for the CMN or physician order to be returned in order to bill the payer.
An effective tracking system for medical documentation is imperative to increased claims submission each month and reduced accounts receivable. Employee accountability and responsibility over this area of the business is crucial to success. Your most effective CMN specialist is someone who is organized, has good people skills, has a good phone presence, and can make relationships with the physician’s office personnel. An office assistant to the physician will work harder to get the information for you, if your CMN specialist has developed a friendly relationship with them.
A systematic process that is known throughout your billing department should be developed to track each CMN and/or PO that leaves the building.
The system should have a specific person(s) who is in charge of the documentation process. This person(s) is responsible for receiving the CMNs from the physician’s office in a specified time frame. The system can be set up either manually or electronically. For a manual system, you could use a 1 – 31 day accordion file or a binder with tabs listing 1 – 31 days. For an electronic system, you can utilize a spreadsheet program or your billing software program if it is set up for this kind of tracking.
CMNs that go out today in the mail should be checked on within 7 days. CMNs sent via fax should be checked on within 3 days. If the CMN has not been received, then a phone call should be made to the physician. If a new CMN has to be resent, then the CMN person needs check on it in 7 days for mail and 3 days for fax. If it is still not received, then a phone call is made again.
Some companies choose to deliver the CMN directly to the physician (if possible) after the second attempt and return to pick it up within a few days.
This process is completed daily. If after three attempts at gaining the CMN from the physician, the Supplier has the option to notify the patient and tell them that if the physician doesn’t return the form then they are responsible for payment on the equipment. This may encourage the patient to contact the physician.
Tenacity and constant vigilance to the process is essential to gaining your documents from the physician.
That’s all I have for you today. I hope I took some of the evil out of this necessity. I know I can’t do much about traffic lights and I am sure I can’t do much about the big purple dinosaur. I shouldn’t be so rough on him, maybe if I tried harder and really concentrated, “Barney could be a friend of mine”
Be well and talk soon. -
HMS is a full service billing solution. If you would like to submit questions about issues that you are dealing with and woud like answered in the next issue please forward them to dstallbaumer@hmsbillingservice.com or call 866-662-1442.