Billing

Article Dean Dorton

Monitoring provider coding and billing risks is a constantly evolving challenge.  One great tool to monitor high risk provider billing in your organization is the Comparative Billing Report (CBR).  CBRs are generated by Medicare Administrative Contractors and summarize Medicare claims data statistics for individual providers.  CBRs are released only to the individual providers they provide data for and present results of statistical analyses that compare an individual provider’s billing practices for a specific billing code or policy group with the practices of that provider’s peer groups and the national averages. Each CBR is unique to its recipient, and each provider sees only his/her own billing data. No data attributable to any specific provider is made publicly available.

While healthcare organizations do not have access to specific providers’ reports or data, CBR topics and national- and state-level data are available online.  Healthcare organizations can combine these datasets with their providers’ Medicare claims data to monitor for potentially high outlier providers within its network.  Dean Dorton has developed an interactive report which breaks down the topics and benchmarks for select CBR topics from recent years.

Dean Dorton Healthcare

Lance Mann, CPA, CFE, CGMA
Assurance Director
lmann@deandorton.com • 502.566.1005

Adam Shewmaker, FHFMA
Healthcare Consulting Director
ashewmaker@ddafhealthcare.com • 502.566.1054

Article Dean Dorton

On-Call Billing: How does it work?

Physicians are all too familiar with the “on-call” system that allows for patients to be seen day and night. When a patient needs care after hours, hospitals and medical group staff may reference the on-call schedule to see which provider is available to meet the needs of the patient. Why not use the same strategy when it comes to billing?

Dean Dorton is excited to announce the launch of On-Call Medical Billing services! We have a team of industry experts dedicated to serving your practice with on-call medical billing and other business office services.

When your staff is absent due to sickness, PTO, maternity leave, etc., you may need interim support to complete critical tasks such as coding, charge-entry, claim submission, and payment posting. Think of us as your on-call billing team, a supplement to your day-to-day staff. Our goal is not to replace your team, but to temporarily augment your staff to ensure cash flow is maintained during extended team member absence.

Adam Shewmaker, Healthcare Consulting Director, Dean Dorton

“Our healthcare team is in constant communication with our clients about challenges they face on a day-to-day basis. It’s no secret that staffing challenges and the current labor market can put a strain on healthcare operations, so we’ve decided to think outside the box in order to help our clients find sustainable, scalable solutions. We’re excited to add another service to our rapidly growing healthcare service line and continue to serve an industry we are so passionate about.”

When to Utilize On-Call Billing Services:

  • Maternity, Paternity, or other FMLA
  • Team member PTO
  • Absence due to sickness or injury
  • Team member resignation or personnel turnover
  • When training team members on new systems

Benefits of On-Call Billing Services:

  • Billing continuity
  • Minimize and prevent backlogs
  • Maintain practice cashflow
  • Minimize customer service issues
  • Access to experienced medical billers
  • Maintain productivity levels

Dean Dorton Service Offerings:

  • Medical coding
  • Chart auditing
  • Billing and claim submission
  • A/R follow-up and denial resolution
  • Payment posting
  • Credentialing

Dean Dorton Healthcare Services

Article Dean Dorton

An effective and patient-friendly customer service team is critical to ensuring a positive patient financial experience. With increased focus on pricing transparency and more knowledgeable consumers, it is the customer service unit within your organization that can greatly determine a patient’s overall financial experience.

These four key principles can help improve your customer service function.

  • Handling all patient complaints and billing concerns. Patients need someone knowledgeable who can help them navigate their statements, be empathetic, and address any concerns they may have about the experience they have had at the organization.
  • Delegating all correspondence and insurance remits. Customer service representatives can provide essential assistance to assigning specific correspondence and remits from insurance companies to the appropriate party.
  • Coordinate and monitor early out vendor. The customer service representatives are vital in monitoring patient statements being sent to the patient timely and in sequence.
  • Monitor and complete self-pay refunds. If a patient pays more than their responsibility, the customer service department can confirm these overpayments and complete a refund for the patient.

As you assess the efficacy of your patient financial experience, consider these key questions:

  1. Does your organization have a dedicated customer service unit and place a specific emphasis around the patient from end to end revenue cycle (scheduling through payment)?
  2. Does your organization have personnel whose main job function is answering phone calls from the patient and addressing their concerns?
  3. Do you consistently field complaints from patients on not receiving their statements timely, not understanding their bill, or feeling as their issue is not addressed?
  4. Does your organization offer tools to the patient that keeps them engaged in their care through an online patient portal or secure messaging system, so the patients can efficiently and effectively reach customer service staff members?

As organizations develop a holistic approach to treating patients, the customer service unit will be critical to addressing a patient’s concerns. This unit can potential lead to recurring patient volumes, increased patient collections, higher HCAHPS scores, less patient complaints, increased efficiency in revenue cycle processes, and risk mitigation. Our experienced healthcare team can aid in implementing a new customer service team and assessing other areas around improving a patient’s experience, as a whole. To learn more about Dean Dorton Healthcare Solutions, follow the link below:

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Chip Dalton, MHA, CPC-A, CRCR
Healthcare Senior Consultant
cdalton@ddafhealthcare.com • 859.425.7683