Amanda Whitener

Our clients should know, our facility should know

where they stack up against industry standards, and are their costs being covered by their allowed amounts.

So they want to look at their Medicare rates, look at their fee schedules, perform routine case costing, and they need to have their contracts to do that effectively.

Two, if they don't have complete copies of their contracts, it tells me it's likely those centers' billing teams aren't referencing the contracts when they're doing their day-to-day work.

And this is so important.

So one thing they may be doing, like let's say they're posting payments, they may be applying a percent of Medicare when confirming EOB payments or working AR.

So that's if they know that the payers allow it a percent of Medicare and if they know that percentage for each payer.

But what about implant nuances?

What about carved out case rates?

Those two things, implants and carve outs, have massive cash implications if not handled properly.

And the team should have access to full contracts to know that level of detail when they're doing their day-to-day work, such as AR or payment posting.

The third thing it tells me is if they don't have complete copies of their contracts, that their charge master could actually be out of date.

And this is their fees that are their charges that are loaded into their practice management system.

And this is where we run into a lot of issues with lesser than language and contracts where the payers actually articulate in the contracts that they'll allow the lesser of billed charges or the actual contractually allowed amount, whatever is lesser.

So it's important to also perform routine charge master analyses to ensure charges are consistent across payers, but sufficient to account for each fee schedule.

Something else I mentioned is coding.

Coding gives both an opportunity to maximize cash.

So example would be procedures that are dictated in the operative report but aren't appended to the initial claim.

We see it.

It happens.