WCH Trains Practice Staff and Nearly Doubles Reimbursements

When a dermatology clinic came to WCH with too many zeros on their EOBs (explanation of benefits), WCH Account Representative Alla Keinig quickly analyzed their in-house billing and turned reimbursements around from less than 50 percent to 95 percent in one month.

She did it the WCH way: providing education, training, and support to help the practice understand and address the issues that were holding them back.

For instance, Alla immediately realized that the front office wasn’t consistently checking patient eligibility. “A medical insurance card is just a card,” she says. “Unlike car insurance, it doesn’t have an expiration date on it. That’s why it’s important to verify insurance is current and find out what is covered under each particular plan.”

Some insurance companies require pre-authorization; and while the same company may cover something under one individual’s plan, they may not under another. The dermatologist and his three physician’s assistants see 60-70 patients a day, six days a week, and it is the responsibility of the front office to confirm insurance coverage for every patient.

Billing Experience Matters

The dermatology practice’s certified in-house biller is a recent graduate. She processed the information she was given, but didn’t have enough experience to realize she needed to ask for more. Consequently, she continued to submit claims for patients even after the insurance company said they weren’t covered anymore.

The in-house biller was also missing opportunities for recouping revenue because she wasn’t familiar with the parameters of the global surgery period rule. While visits related to a minor surgery are included in a single global surgery reimbursement, unrelated issues addressed during a follow-up visit warrant a new, separate claim. The office staff just didn’t know.

Basically, the biller wasn’t getting the information she needed. The office staff needed education. And the entire system had to change.

Finding a Better Way

To define the issues requiring attention, Alla sorted EOBs according to problem—lack of authorization, eligibility, or global surgery billing—and created a comprehensive training program for the front desk, doctor, office manager, physician’s assistants and biller.

WCH’s Information Technology (IT) department helped office staff log on to insurance company portals and see how easy it is to check patient eligibility and view claims. “We showed them how to access each insurance site and quickly retrieve information before treating a patient,” says Alla.

“They didn’t know this was an option,” she adds. “They thought they had to call insurance, which can be very time consuming and require entering a lot of information. Web access takes 30 seconds. After a few remote and onsite sessions, they were comfortable utilizing the portals.”

Making Time for More

The in-house biller now understands what to submit to WCH to produce consistently clean claims. In fact, 95 of the initial 100 claims WCH submitted for the dermatologist were reimbursed. (The five claims that weren’t covered were for procedures the provider knew would not be reimbursed.)

An added bonus: now that the business side of the practice is running more smoothly and claims are being paid, the doctor has the time and resources to work on new treatments for pediatric cancer patients. “He’s doing very important work with children who have skin issues caused by chemotherapy treatments,” says Alla. “It’s been so rewarding getting to know the provider and his staff, and helping them improve their revenue cycle management so they can focus on their patients and both medical and personal pursuits.”

WCH Helps New Clients

“It’s critical to invest time in the beginning for training and for auditing existing billing and compliance practices,” says Alla. “We help practices understand their problems first, so we can work on fixing them together. Many issues can easily be avoided if a practice puts new systems in place with an experienced external biller.”

“If in-house staff continues working with us the same way they always have, they won’t realize any improvements in reimbursements,” says Alla. “We show clients how to work in new ways to become more successful. That’s how WCH is different. We guarantee we will find missing legitimate and misfiled claims that will bring more revenue back into the practice.”