 |
Invoice Generation at the Billing Agent
Once the medical record and demographic information reach the billing agent, a series of
processes will convert the encounter into a billed invoice. Each of these processes requires
exquisite attention to detail in order to avoid revenue degradation.
Important points to consider are:
- Encounter tracking protocols
- Tax Identification Number security
- Software/hardware security and daily system back-ups
- Audit trails
- Coding protocols and QA
- Electronic claim transmission
- Dunning cycles and balance billing protocols
- Customer service-phone waiting times and abandonment rates
- Lines of communication to the physician and hospital
Effective billing for emergency physician services is NOT an esoteric exercise. Each step needs to
be closely monitored for performance and accuracy. BSA Healthcare utilizes its
members' extensive experience in billing operations to help the physician, or hospital, achieve the
highest productivity from their billing agent.
Frequently Asked Questions
Should the EP be concerned about the physical plant of the billing agent?
Yes. Natural disasters, including fire, do occur. Certain types of business interruption insurance can
protect against cash flow disruptions. However, it is best to talk with the billing agent to review their
disaster recovery plan. All computer systems should be backed up daily, with off-site storage of the backup
data. To protect against prolonged closure of the billing agent due to fire, flood, etc., a "hot site" should
be contracted for allowing billing to resume within a reasonable timeframe.
Do the prudent layperson laws allow the billing agent to avoid inclusion of authorization information on the claim?
Although "prudent layperson" legislation is becoming more common, it still applies to only a fraction of the
managed care patient encounters in the E.D. A "prudent" course of action is to continue to receive authorization
information whenever available, and ensure that the billing agent is entering that information on the claim.
Should the EP care about internal operations of the billing agent?
The efficiency of various billing agents can differ dramatically. Some agents have tight controls of all encounter
and financial information, answer calls promptly, have quick turnaround times for coding, data entry, correspondence
and payment posting. Other agents have poor controls and frequent logjams in production work. Ultimately, the EP group
will suffer financially if billing operations are sub-optimal. Having an ED group representative who meets with the
billing company leadership on a frequent basis is crucial to establishing and maintaining lines of communication, and
ultimately protecting your revenue.
BSA Healthcare Services
EMERGENCY MEDICINE & PHYSICIAN SPECIALTY SERVICES
| HOSPITAL SERVICES
| | | | | |
