In an effort to help you maximize all your services, Dr. Daniel Dahan has identified 7 departmental areas in your practice, which need to be addressed. Each of these areas is being dealt with sequentially in The American Chiropractor. By following the suggestions given, your office will not only maximize its potential, but also delineate areas of weakness that need your attention.
3. Billing Department
As is well known, the billing department has the most critical job in any one office. Indeed, insurance companies, as well any third party payers, use highly computerized systems to analyze and sort through doctors’ claims. Hence, the billing department must pay close attention to make sure that every detail on an HCFA 1500 form is not only accurate but appropriate. Accuracy has to do with the code which best describes the service rendered. Appropriateness deals with the usual and customary fee as well as repetitive use of any particular code.
The billing department should conduct continuous reviews/audit:
- Weekly: Auditing the accuracy of codes used.
- Monthly: General review of reimbursement for each code per service.
- Quarterly: Thorough in-depth look at how codes are being classified by payers and if there are any updates to implement.
The biller should be experienced and qualified. It is highly recommended, as well, that he/she be certified. One qualified biller is necessary for every $500k billed per year.
The doctor should meet with the biller weekly to get a complete analysis on any follow-ups made. Changes should be posted daily and, typically, billed at the same time. For the smaller offices (i.e.,< $8k per week) billing can be done 1-2 times per week to cut down on setup time. The biller should have a current CPT codebook, a zip code driven fee analyzer, “code it right” manual and the ICD-9 book.
Even with the best treatments and remarkable office protocols, unless codes are billed properly, reimbursement will be very weak.
Dr. Daniel H. Dahan is the founder and CEO of Practice Perfect, one of the nation’s largest management and consulting firms for multidisciplinary centers. For more information, call 866 67-DAHAN, (866) 673-2426 (Toll Free #), email
or visit www.dahan.com.