One would love to assume that hospital admitting staff are focused on capturing all the information necessary to get the hospital paid and that this should include what is necessary to get the providers paid. The reality is that the requirements of the facility are not always in alignment with those of providers. In addition, it is not always clear that facilities and their staff are as focused on optimizing collections as are the staff working for the providers.
At Cross Purposes
Understanding the fundamental disconnect between physician and facility billing is the key to a successful solution. When a patient is admitted to a hospital, the admitting clerk is instructed to compile a complete registration form online, known in billing parlance as the patient demographic (“demo,” for short). It is intended to satisfy the various requests of hospital-based services. The specific requirements of anesthesia billing are a secondary priority.
As a general rule, hospital data is accurate and complete much of the time but not all the time. A quick survey of Coronis Health employees working with a variety of clients across the country indicates that the completeness and accuracy of the demographic data represents a wide range of accuracy. When the demographic details of a case are missing, incomplete or inaccurate, this creates additional work for the billing staff. This information must be identified and verified. Someone must be responsible for this.
Gaps in Data Gathering
The assumption is that automated anesthesia records and direct data feeds from hospital admitting data to the billing system minimize omissions and errors, but this is not always the case. Every system has at least one rate limiting step. Admitting clerks are good at capturing name, address and insurance information for surgical patients when there is adequate time to process them, but deliveries and emergencies always pose problems. Non-OR procedures often require special handling as the clinical records must be separately identified and tracked. Coronis Health management reports provide details of all services performed across all locations.
Getting paid by American insurance plans is an arcane discipline in itself. Medicare is a perfect example. The hospital gets paid under Part A, but doctors and other professional practitioners get paid under Part B. Capturing the Medicare number allows the provider to be paid 80% of the allowable but not 100%. It is critical that the hospital clerk capture the co-insurance because failing to do so might result in billing the patient the remaining 20% instead of the secondary insurance. Most hospital admitting departments do not capture or copy primary insurance cards, which is often a problem.
Avoiding Setbacks
Many of the cases that ultimately get referred to collections are the result of patients whose demographic information was not verified at the time of service. One of the most critical determinations that the billing staff must make when a claim is prepared is whether the patient actually has insurance. As the technology of collections evolves, it becomes ever more complicated to know how best to target patients. Sending out statements is just one piece of the puzzle. Most patients with caller ID no longer respond to collection calls. As a result, we have added additional methods of communication such text messages. It is not a perfect solution but it can be quite effective. The key requirement is that accurate phone numbers are captured up front.
Because the information captured by the admitting clerks can impact the collections that offset hospital financial support to the anesthesia practice, we recommend the anesthesia practice to share its demographic quality measures with administration. The objective is to share creative ideas and strategies that might enhance collections. It can also be helpful to make administration aware of any new approaches, such as the use of text messages.
Effective collections are not the result of luck and timing. They are the result of focus and discipline. Optimizing the completeness and accuracy of patient demographics is the new frontier we must all traverse with resolve and assiduity.