“The AMA tells us that 20% of all claims are denied. The insurance industry says that clean claims are denied only 2-3% of the time. So what we strive for are clean claims,” says Sarah, who points out that there are three phases involved in generating a clean claim: pre-visit, visit and post-visit. Even before the visit, however, there are important issues related to clean claims that must be addressed. “Negotiate your contracts well and make sure that your physicians are credentialed properly so that they get paid when they work,” says Sarah.

Pre-visit: “A clean claim starts at the front desk, but too often the front desk staff doesn’t understand their role in the revenue cycle,” says Sarah. “The revenue cycle is everybody’s job and it all starts before the patient arrives.”

Sarah recommends looking carefully at the CMS claim form to ensure that all necessary information is gathered from patients. And, she says, copy a patient’s insurance card at every visit. “If you go to Ruby Tuesday for lunch three days in a row, you’ll give them your credit card every time,” says Sarah. That’s a great analogy, because just as people change which credit card they use from time to time, patients may change jobs, get new insurance, or lose insurance from visit to visit. Be sure, too, to get information release forms signed by patients and give them a copy of your payment policy so they understand that ultimately they are responsible for charges incurred.

Once you have all of the patient information you need, make sure it’s entered into the system accurately. One transposed number is all it takes for a claim to be kicked back. “Information should be double checked by a second person on the day of the visit,” says Sarah.

Visit: “The visit is when you create expectations with patients,” says Sarah. She recommends collecting co-insurance payments at the time of service and establishing the fact that patients are responsible for any balance due after their insurance pays or for the entire balance if their insurance does not pay.

Correct diagnosis and CPT codes are essential for clean claims, so take steps to ensure that everyone in the office involved in the revenue cycle is trained and up to date in this important area. “Codes must be accurate,” says Sarah. “Educate your staff, and remember that the front desk staff needs to be equally educated.”

Timeliness in several areas is important when it comes to the patient visit. “Make sure that the clinic portions of visits are dictated immediately,” says Sarah. “The sooner a claim is filed, the more apt is it to be paid, so you’ve got to create the expectation with physicians that claims must be filed daily. Don’t let things sit,” she says.

Post-visit: “The most important thing about the billing process is assigning duties and holding people accountable for what they’ve been assigned,” says Sarah. Having the right people in the right jobs is also a factor. According to Sarah, the ideal billing staff employee is self-reliant, responsible, reliable and a good communicator. “When you give them work to do, they should act with autonomy,” says Sarah, who is also a fan of cross-training. “Rather than have one person do all the work for one doctor or one insurance, they should be cross-trained,” she says. “Divide the work up so that everyone is getting experience across the board.”

The billing process should be streamlined so that clean claims get paid with as little hands-on staff time as possible. “Automate everything you can,” says Sarah. Doing so frees up your highly trained staff to deal with the few claims that are denied and to communicate with patients about the status of their medical bills–something your computer system cannot do.

Those who have already bought the posters  are in 100% compliance with the posting requirement.   This new posting is still expected to go into effect … just at a later date than expected.

Posters ordered at this time are in compliance with the requirement that nearly all private-sector employers  notify employees of their rights under the National Labor Relations Act (NLRA) by posting a notice.

If you’re interested in following the AMA’s activities around this issue, start here (scroll down to the paragraph labeled “Stop the Implementation of ICD-10″), then check their Web site regularly for updates. Read an article from Medscape Today News about the AMA’s action here. (You’ll have to sign up for a free account to access Medscape, if you don’t already have one.)

For the view from the U. S. Department of Health and Human Services, visit the Centers for Medicare & Medicaid Services (CMS information page here. At this site you can sign up for e-mail updates and follow the CMS on Twitter.

The AAPC, an association founded in 1998 to provide education and certifications for professional coders, offers good information on their Web site. The organization offers two-day trainings around the country as well as on-site training and assessments to help practices prepare for next October.

The American Health Information Management Association (AHIMA) Web site features extensive information on the transition to ICD-10, including a comprehensive FAQ section that you may find helpful. This organization also offers educational seminars, a wide array of webinars and publications (some for free, some for purchase) and a list of available trainers.

For ICD-10 information that is more specific to your practice, check with the specialty associations (American College of Physicians, American Association of Family Physicians, American College of Surgeons, etc.). Your local county or state medical society should also have information on local resources and training. This is a good time to make use of your association and professional organization memberships.

The National Labor Relations Board has recently issued a rule that requires nearly all U.S. businesses to post a notice to employees communicating their rights under the National Labor Relations Act. Covered employers must replace their federal poster by November 14, 2011, to remain in compliance.

The new posting is mandatory regardless of your company’s union status. It applies to both union and non-union workplaces alike.

The easiest and most effective way to protect your business is with the ComplyRight™ Federal Poster. This convenient all-in-one poster includes the new NLRB notice and the six other mandatory federal postings. Another option is the ComplyRight Federal and State Kit. This poster set meets every federal and state requirement to keep your business in full compliance.

The deadline to comply is November 14. A word of caution: Noncompliance can be treated as an “unfair labor practice” and can be used as damaging evidence in a lawsuit.

Below is a list of Frequently Asked Questions about the situation.

FAQs

Q: What if my business is non-unionized? Do I still have to comply?
A: Yes, this new poster is mandatory regardless of your company’s union status. It applies to union and non-union workplaces alike.

Q: You said “nearly” all employers have to post the new notice. What are the exceptions?
A: At this time, the requirement does not apply to agricultural, railroad or airline employers — or the U.S. Postal Service. In addition, some very small businesses and retailers may be exempt. If you believe your company falls into this category, confirm with your accountant or financial professional. Noncompliance can be treated as an “unfair labor practice” and can be used as damaging evidence in a lawsuit. 
 
Q: Is this a separate posting?
A: No, it is included on the federal poster with the other required notices, such as OSHA, Federal Minimum Wage, etc.

Q: How large is the poster?
A: The laminated poster is 24” x 32.75”.

Q: Is there an electronic posting requirement?
A: Yes, if you typically post company policies on an Intranet or Internet site, you must post this notice there as well. Our poster includes a URL where you can download a free electronic copy. The URL is contained in an employer note on the printed poster.

Q: Do I need to post this in Spanish?
A: This notice must be posted in other languages if 20 percent or more of your workforce is not proficient in English. The Spanish version of the NLRB posting is included on the ComplyRight™ Spanish Federal Poster.

Q: What is the fine for not posting?
A: There is no specific fine connected with this posting. However, noncompliance can be treated as an “unfair labor practice” and can be used as damaging evidence in a lawsuit. There are fines, however, attached to the other required federal postings — OSHA, for example. You can be fined up to $17,000 per location for not displaying current federal notices.

To order Florida prescription blanks click here.

On December 8, 2010 Congress passed legislation that exempts physicians from the FTC’s Red Flag Rules. For more information on you can visit the Physicians Practice blog at: http://www.physicianspractice.com/blog/content/article/1462168/1752034

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