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WCH News

October 19, 2014

Medical billing is the process by which a medical biller converts information about medical service, performed by healthcare provider into appropriate claim format. The duty of the medical biller is to ensure that the provided data is entered accurately, however in WCH the duties of the medical biller go beyond just claim submitting. Our professional medical billers strive to submit a clean claims to payers on behalf of the clients. This should be achieved not only with our staff knowledge, but also requires close and consistent communication between healthcare provider and billing staff. It's an obligation of healthcare provider to monitor the process of medical billing. We strongly advise our clients to conduct regular meetings with their account representatives in WCH.

  • Compliance governing organizations such as OMIG and OIG state that communication between providers and billers is a requirement. OIG Policy states that practices must create a mechanism for the billing staff to communicate effectively and accurately with the health care provider. Regular involvement and communication between providers and billers serves to prevent fraud and increase practice compliance.
  • Regular communication between providers and billers improves the overall practice reimbursement, compliance as well as accuracy. When discussing the medical services billed, the biller can advise on code assignments to accurately describe the service that was ordered by the physician; the biller can discuss proper coding and ensure that only accurate and properly documented services are billed according to insurance policies.
  • Establishing and maintaining a process for denial review results in increasedreimbursement.Getting to know the reason for claim denials and how they can be avoided improves revenue levels. The billing representative reviews the entire process from front desk to claim submission and identify reasons for claim denial and correct errors; the close communication prevents the same errors from happening in future claims and saves the provider time and money.
  • Communication with billing staff adds a layer of protection to the practice, especially in a multispecialty group. Controlling that proper codes are used and timely documentation of all physician is obtained prior to billing to ensure that only accurate and properly documented services are billed;

WCH has encountered cases in which providers were not communicating enough with the billing staff which resulted in issues that could have been easily avoided. We are here to help you! Talk to us!

Set up regularly schedule meetings with your account representative today.

Real Cases, don’t let it happen to you!

Case 1:  Dr. P had no time to speak with his billing representative; he always referred all questions to the office administrator. The administrator’s lack of clinical experience led to him make inaccurate corrections on the superbills. As a result, the claims were billed with incorrect data which caused denials and overall audit issues by the insurance company.

Case 2:
Dr. A mostly submitted superbills with high level visit, CPT 99204. The biller repeatedly requested progress notes from the doctor to verify that this procedure is properly documented. Dr A never responded to the biller’s request for documentation. Eventually this resulted in the doctor receiving letter from the insurance company due to being the highest among his peers to bill this level of care.

Case 2: Dr. Z was not aware that management submitted his diagnostic test as a global procedure while he performed only reading. We have attempted to contact the doctor to verify if this superbills are correct and clear, but doctor always referred us to management of the office. Biller was instructed to by management to submit the claims. Medicare requested medical records to support the global billing. As a result physician was placed on prepayment review.

Regular communication between providers and billing staff adds many benefits that improve the process of billing and prevents issues as described above from occurring. Weekly discussions of about 15 minutes can make a difference in any practice operation. Tight communication between the biller and provider is a regulation imposed by OIG and OMIG with a goal to improve compliance, increase reimbursement levels, ensure accuracy and add a level of protection to the practice. WCH Medical Billing professionals strongly encourage high level of involvement in effectively communicating with billing staff on a regular basis.

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Shabbat Time
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