Money Matters - An HCET LearningLink On-line Training Module

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6. Billing

Your ability to bill starts at the first contact. The patient telephone call or walk-in allows us to “set the stage.”

A private physician’s office does not hesitate to ask: “How do you intend to pay your bill?”
People are more compliant in providing needed information before they see a provider

Be sure to bill for ALL the services you provide at the visit. Many items are overlooked, not coded, or intentionally left off the encounter form.

A few important suggestions:

Educate providers not to worry about the client’s ability to pay – that is dealt with elsewhere
Consider “economies of scale.” It may pay for two or three agencies to combine their billing departments (computers, staff, etc.)
Consider outsourcing. Billing vendors may be cost effective. Check references! You are still liable for everything they do in your name

You may also offer a prompt pay discount. This provides a “time value” to money.

Offer to anyone or any entity settling an account at time of service
This is not a reduced charge but an adjustment (language is critical)
It is different from financial hardship, i.e., hardship should be slightly more to encourage prompt payment
This concept allows for the scale to go above 250% in family planning programs
Insurance companies are afforded the same discount IF they can pay at the time of service

Note that coding drives the bill. ICD-9 (diagnosis codes) are tied to the CPT codes.

Identify all diagnoses, symptoms, conditions, problems, complaints, or reason for service or procedure
List the primary condition first, then current active conditions and/or issues
Utilize all five digits if possible; be as specific as possible
Code symptoms, signs, conditions, test results, or other reasons for the encounter
Code all conditions that coexist at time of service that require or affect patient care, treatment, or management

Do NOT code what no longer exists!

“Probable”, “suspected”, “rule out”, or “questionable” diagnoses should not be coded until the diagnosis is confirmed
Ancillary diagnostic service: list diagnosis or problem initiating service first, “V” code second
Be sure to use the appropriate CPT and ICD-9 codes

Remember: Blessed are the Diagnostic Codes
for they shall get us paid!

For more information on CPT and ICD-9 coding

Section: Main 1 2 3 4 5 6 7 8 9 10

©Health Care Education & Training, Inc.
URL: http://www.hcet.org/training/Mmatters/ModIII/6billing.htm
Last update: 04/22/08