Provider Based Billing And Coding For RHCs - PowerPoint PPT Presentation

1 / 72
About This Presentation

Provider Based Billing And Coding For RHCs


Two services never should be billed as face to face visits. ... A face-to-face service beyond that which occurred when the intervention was ... – PowerPoint PPT presentation

Number of Views:1501
Avg rating:3.0/5.0
Slides: 73
Provided by: deborahh2


Transcript and Presenter's Notes

Title: Provider Based Billing And Coding For RHCs

Provider Based Billing And Coding For RHCs
  • Presented by
  • Deborah Holzmark, RN, MBA, CPHQ, MCS-P , CMPE
  • Dixon Hughes PLLC
  • (828) 236-5794

  • Types of Services - Covered and Non-Covered
  • Providers of Service
  • Specific Services
  • Medical Record Requirements
  • Changes for 2006
  • AR Management

  • Types of Services
  • Covered and Non-Covered

  • Types of Services - Covered and Non-Covered
  • The services provided at a rural health center
    can be divided into four categories
  • Face-to-face encounters (or "visits").
  • RHC services incident to a face-to-face
    encounter. These services are not directly billed
    but are reimbursed through the cost report.
    Incidental services are typically provided by non
    practitioners under general physician/extender
    supervision, although practitioners (particularly
    therapists who are directly employed by the RHC)
    frequently also provide incidental services.

  • Types of Services - Covered and Non-Covered
  • Non RHC services. RHCs can provide Part B
    covered services that do not fall within their
    congressional mandate. Examples include physician
    services to hospital inpatients and physical
    therapy by contracted therapists. Non RHC
    services are not reimbursed under the all
    inclusive rate rather, they must be billed
    separately to the appropriate carrier.
  • Non-covered services. Non-covered services may be
    provided and billed directly to RHC patients.
    However, in no instance can Medicare
    beneficiaries be billed for services that would
    be covered under Medicare.

Covered Services
  • The services offered in a Rural Health Clinic
    (RHC) are the type of services that patients
    receive in a doctors office, an outpatient
    clinic or emergency room. Such services are
    physicians diagnostic, treatment or consultation
    services. In an RHC, the services may also be
    provided by a nurse practitioner, physicians
    assistant, certified nurse midwife, clinical
    psychologist or clinical social worker.

Covered Services
  • Services are covered in an RHC if the following
  • Medically reasonable and necessary.
  • The service is provided by a physician, nurse
    practitioner, physician assistant, certified
    nurse midwife, clinical social worker or clinical
    psychologist who is employed by or receives
    compensation from the clinic.
  • If not provided by a physician, the service is
    provided under the general supervision of the

Covered Services
  • The service is provided in accordance with the
    clinics policies, protocols, standing orders or
    any physicians medical orders for patient care
    and treatment.
  • If not provided by a physician, the service is
    permitted by state law for the nurse
    practitioner, physician assistant, certified
    nurse midwife, clinical psychologist or clinical
    social worker to provide the service.
  • If not provided by a physician, the service would
    be covered by Medicare if performed by a

Non-covered Services
  • Services not covered in an RHC as clinic services
    but may be covered under other Medicare benefits
  • Durable Medical Equipment (DME) (whether rented
    or sold) including iron lungs, hospital beds used
    in the patients home, wheelchairs, etc.
  • Ambulance services.
  • Prosthetic devices, which replace all or part of
    an internal body organ (including colostomy bags)
    and supplies directly related to colostomy care,
    and the replacement of such devices.

Non-covered Services
  • Leg, arm, back and neck braces and artificial
    legs, arms, and eyes, including replacements if
    required, because of a change in the patients
    physical condition.
  • Physical, speech or occupational therapy with a
    therapist not employed by the RHC.
  • Screening mammography.
  • Technical components of diagnostic tests.
  • Contracted non-physician diagnostic or
    therapeutic services are also excluded from RHC

Non-covered Services
  • No payment can be made under Medicare Part A or
    Part B for items and services with the following
  • Not reasonable and necessary.
  • No legal obligation to pay for or provide.
  • Furnished or paid for by government
  • Not provided within the United States.
  • Personal comfort.
  • Routine services and appliances.
  • Supportive devices for feet.

Non-covered Services
  • Custodial care.
  • Cosmetic surgery.
  • Charges by immediate relatives or members of
  • Dental services.
  • Paid or expected to be paid under a Medicare
    Secondary Payer (MSP) provision.
  • Or,
  • Non-physician services provided to a hospital
    inpatient that were not provided directly or
    arranged for by the hospital.

Non-covered Services
  • Visits for the sole purpose of obtaining or
    renewing a prescription, in which the need was
    previously determined (so that no examination of
    the patient is performed), are not covered
  • Time used in completion of claim forms.
  • Care-plan oversight is not allowed by either Part
    A or Part B for RHC providers

Services Incident To
  • Services and supplies incident to an RHC
    practitioners (physician, physician's assistant,
    nurse practitioner, nurse midwife and clinical
    psychologist) professional services are covered
    as RHC services as long as the services are
    supplies are
  • Furnished as an incidental, although integral,
    part of an RHC Practitioners services.
  • A type commonly furnished either without charge
    or included in the RHCs bill.
  • A type commonly furnished in a physicians
  • Services provided by clinic employees that are
    furnished under the direct and personal
    supervision of an RHC practitioner.
  • Furnished by a member of the clinic or staff who
    is an employee of the clinic.

  • Coverage is limited to situations where there is
    direct supervision of the clinic staff performing
    the service. Direct and personal supervision does
    not mean that the RHC practitioner must be
    present in the same room. However, the
    practitioner must be on the premises and
    immediately available to provide assistance and
    direction throughout the time the clinical staff
    is performing services. In other words, if no
    mid-level or physician is on the premises
    auxiliary staff may not provide any medical

Services for Lab Tests
  • Lab tests
  • An encounter expressly for the purpose of
    obtaining blood for lab tests does not constitute
    a medically necessary face-to-face visit even if
    a face-to-face contact with the provider is made.
    To be considered as a face-to-face visit, there
    must be some additional medically necessary
    evaluation or management component.

Services without Visit Requirement
  • For services that do not qualify as a billable
    visit, the usual charges for the services are
    added to those of the appropriate (generally
    previous) visit. RHCs/FQHCs use the date of the
    visit as the single date on the line item.

Medical Necessity
  • Medical Necessity
  • Thus there are situations in which the provider
    of the service (e.g. the person giving an
    injection) may be a qualified practitioner and
    the service (e.g. the injection) may be medically
    necessary but it is not medically necessary to
    have the practitioner re-examine the patient to
    deliver the service. In these cases it is the
    physician/extender services that are medically
    unnecessary using physician/extenders for
    services routinely performed by ancillary staff
    does not create additional reimbursable
    face-to-face encounters as Medicare is
    specifically prohibited from reimbursing
    medically unnecessary services

Services to Others
  • Medicare and Others
  • If you provide to others, must provide to
    Medicare beneficiaries
  • Non Rural Health
  • Cant move pt back and forth to get
    reimbursement- allergy injection example

Providers of Service
Providers of Service
  • Physicians
  • Non-physician practitioners

NP/PA Other Locations
  • Full-time and part-time nurse practitioners,
    physician assistants (including nurse midwives)
    who are employees of an RHC or who are
    compensated by the clinic for providing services
    furnished to the clinic's patients in locations
    other than at the clinic, may furnish services to
    clinic patients at the clinic or in other
    locations, such as the patients home. These
    services are RHC services and are reimbursable
    only to the clinic. Clinic patients include
    individuals who receive services at the clinic
    facility or services provided elsewhere. These
    costs are included in the costs of the RHC.

Non-Physician Practitioners
  • Clinical Psychologist
  • Diagnostic and therapeutic services that the CP
    is legally authorized to perform in accordance
    with State law and regulation.
  • Services and supplies furnished incident to a
    CPs services are covered if the requirements
    that apply to services incident to a physicians
    services, as described in 60, are met and they
    are furnished by an employee of the RHC or FQHC.
    To be covered, these services and supplies must
  • Mental health services that are commonly
    furnished in CPs' offices
  • An integral, although incidental, part of
    professional services performed by the CP and
  • Performed under the direct personal supervision
    of the CP, i.e., the CP must be physically
    present and immediately available.
  • Appropriate State laws and regulations governing
    a CPs scope of practice must be considered.

Non-Physician Practitioners
  • CSW
  • RHC services include the services provided by a
    clinical social worker. A clinical social worker
    is an individual who
  • Possesses a master or doctors degree in social
  • Has performed at least two years of supervised
    clinical social work and, is either licensed or
    certified as a clinical social worker by the
    state in which the services are performed.
  • Or,
  • In the case of an individual in a state that does
    not provide for licensure or certification, has
    completed at least two years or 3,000 hours of
    post masters degree supervised clinical social
    work practice under the supervision of a masters
    level social worker in an appropriate setting
    such as a hospital, Skilled Nursing Facility
    (SNF) or clinic.

  • Two services never should be billed as face to
    face visits. Medical nutritional therapy, in
    accordance with BIPA 105, must be provided by a
    registered dietician or nutrition professional
    it is therefore an "incident to" service for
    which costs are reported but no visit. Diabetes
    self management (DSM) represents a similar
    situation. PM-A-00-30 identifies DSM as an RHC
    service, but MIM 3619 specifies that G0108/9
    codes are not payable for beneficiaries receiving
    services in an RHC. Although DSM (as defined in
    Section 4105 of the BBA of 1997) must be
    certified as medically necessary by a
    physician/extender, the actual educational
    intervention is usually provided by other
    professionals, typically nurses. A face-to-face
    service beyond that which occurred when the
    intervention was ordered (certified) is not
    medically necessary. Therefore it too is an
    "incident to" service for which costs may be
    reported but no visit reported. Lacking technical
    components, neither of these services would
    generate Carrier claims either.

RHC Billing and Reimbursement
  • Provider Based billing to FI servicing the main
  • Billing on CMS 1450 (UB-92 or electronic
  • Services billed at your set charges, not expected
    reimbursement (exception Medicaid in some

RHC Billing and Reimbursement
  • Third Party Reimbursement
  • All inclusive rate current upper payment limit
  • Exceptions in provider based with less than 50
  • Other exceptions
  • Patient Portion
  • Deductibles
  • Based on incurred- your billed charge
  • Co-Pays
  • 20 co-insurance based on incurred- your billed

2007 Deductible
  • The amounts indicated below represent the
    deductible and coinsurance applicable to services
    provided in Rural Health Clinics.
  • Deductible 131 per calendar year.
  • Coinsurance Twenty percent (20) of covered
    Medicare services.

RHC Billing and Reimbursement
  • Bill Types
  • RHC Bill Type 71X
  • Third digit
  • 710 non payment/zero
  • 711 Admit through DC
  • 717 Replacement
  • 718 Void/cancel

RHC Billing and Reimbursement
  • Revenue Codes
  • CPT Codes
  • Effective with dates of service on or after April
    1, 2005 FQHC/RHCs are no longer required to use
    HCPCS codes when billing for RHC/FQHC services.
    Charges only are entered on the revenue code
    line. Medicare Claims Processing Manual Chapter

RHC Billing and Reimbursement
  • 0521 Clinic visit by member to RHC/FQHC
  • 0522 Home visit by RHC/FQHC practitioner
  • 0524 Visit by RHC/FQHC practitioner to a member
    in a covered Part A stay at the SNF
  • 0525 Visit by RHC/FQHC practitioner to a member
    in a SNF (not in a covered Part A stay) or NF or
    ICF MR or other residential facility
  • 0527 RHC/FQHC Visiting Nurse Service(s) to a
    members home when in a home health shortage area
  • 0528 Visit by RHC/FQHC practitioner to other non
    RHC/FQHC site (e.g., scene of accident) Charges
    for the interpretation of diagnostic tests
    performed by RHC staff (physician or midlevel)
    are included with the charges for the encounter
    under revenue code 52X.

RHC Billing and Reimbursement
  • Dates of Service
  • A single date should be reported on a line item,
    not a range
  • Reporting Units
  • Non-visit day services
  • For services that do not qualify as a billable
    encounter, the usual charge for the services are
    added to those of the appropriate (previous or
    subsequent) encounter.

Specific Services
Technical Components
  • Technical services/components associated with
    professional services/components performed by
    provider-based RHCs or FQHCs are billed by the
    base-provider on the TOB for the base-provider
    and submitted to the FI

Specific Services
  • Lab Services
  • UA
  • Hemoglobin or Hematocrit
  • Blood Sugar
  • Stool for occult blood
  • Pregnancy
  • Primary culturing for transmittal to certified

Lab Follow-up Clinics
  • Lab Follow-up Clinics
  • Visits to lipid clinics, prothrombin (Coumadin)
    clinics and other lab-based follow-up clinics
    generally do not demonstrate a need for
    physician/extender face-to-face discussion of
    results other than in the two or three visits
    following diagnosis. Exceptions are expected to
    demonstrate a well-documented and unique need for
    the face to face interaction. The routine use of
    a visit to discuss lab results is clearly not
    medically necessary medical necessity for this
    is discussed above.

Preventive Services
  • Preventive Services
  • Unless specifically covered by statute, primary
    preventive services are not covered and are
    additionally not considered to be medically
    necessary for the diagnosis or treatment of
    disease. Screening tests are not medically
    necessary for diagnosis when used for screening
    they are only considered medically necessary when
    used in the diagnosis or exclusion of suspected

Preventive Services
  • Preventive services therefore include
  • medical social services,
  • most nutritional assessments,
  • preventive health education,
  • prenatal and postpartum care,
  • routine physicals (including well child care),
  • immunizations,
  • eye and ear screening,
  • family planning,
  • routine screening procedures (urine dipstick,
    stool guaiac, serum cholesterol, weight and BP),
  • risk assessment (including undirected history
    taking and physical exam to ascertain risks), and
  • thyroid screening, among others

Preventive Services Exception!
  • Welcome to Medicare Physical
  • The specific guidance regarding RHC billing is as
  • RHCs and FQHCs should follow normal billing
    procedures for RHC/FQHC services.
  • Encounters with more than one health professional
    and multiple encounters with the same health
    professionals that take place on the same day and
    at the same location constitutes a single visit.

Preventive Services
  • Welcome to Medicare Physical
  • The technical component of the EKG performed at a
    provider-based RHC/FQHC is billed on the
    applicable TOB (Table 3) and submitted to the FI
    using the base provider number and billing
  • RHCs and FQHCs use revenue code 052X. Effective
    April 1, 2005, RHCs and FQHCs will no longer have
    to report additional line items when billing for
    preventive and screening services on TOBs 71x.
    Except for telehealth originating site facility
    fees reported using revenue code 0780, all
    charges for RHC services must be reported on the
    revenue code line for the encounter, 052x, or

Pneumococcal and Influenza
  • Influenza/Flu and Pneumonia Vaccines should not
    be submitted to Riverbend GBA on a UB-92 claim
    form. Instead, when submitting your year end cost
    report , include a listing of those vaccines
    administered to your Medicare patients. The
    listing should include the following information
  • 1) The patients Name and Medicare number.
  • 2) The date of service.
  • 3) The type and cost of each immunization.
  • DO NOT, however, include vaccines administered
    to patients covered under the new Medicare
    Advantage plans on your listing to Palmetto GBA.
    You should bill each respective Medicare plan for
    those services.

  • Injections
  • A visit solely to receive an injection does not
    constitute a medically necessary face-to-face
    visit if the need for the injection was
    previously determined. This is true even if a
    face-to-face contact is made. CMS Pub 100-4,
    12-200, RHC 27-406, CMS Pub 100-4, 17-20, PIM

Allergy Shots
  • Allergy shots
  • A visit solely to receive an allergy shot does
    not constitute a medically necessary face-to-face
    visit even if a face-to-face contact is made. The
    allergy shot is generally administered by
    ancillary personnel and represents a service that
    is incident to a prior physician visit. However,
    if the patient has an adverse reaction that
    necessitates a physician/extender evaluation (and
    that examination, assessment and plan is
    appropriately documented), the encounter may then
    be appropriately billed as a face-to-face visit.

  • Vitamin B12. The IM administration of B12 may be
    transiently necessary in any B12 deficiency state
    but is only medically necessary chronically
    following a definitive diagnosis of pernicious
    anemia (Schilling test, radiolabeled B12 uptake
    and/or other standard diagnostic criteria).
    However, even when appropriately administered, a
    face to face encounter is not medically necessary
    with each injection. In the setting of newly
    diagnosed B12 deficiency with symptoms, patient
    evaluations may be required weekly times four and
    then monthly times twelve. In the absence of
    symptoms attributable to B12 deficiency, two or
    three visits within the first six months may be
    necessary for patient education and re-evaluation
    . Following this initial period, annual visits
    may be necessary (whether or not the patient is
    continuing injections) if the patient is not
    being otherwise seen for chronic problems. More
    frequent physician/extender encounters are not
    medically necessary due to the slow rate of
    relapse following B12 repletion.
  • Flu shots and vaccinations (influenza, hepatitis
    B and pneumonia vaccines) do not necessitate a
    face to face visit.

  • Other injections (such as epogen) also usually
    represent incidental services when the need for
    the injection is previously established, even if
    the physician/extender specifies a change in
    dosage. This is because the physician/extender is
    merely responding to a lab test a re-evaluation
    of the patient is not indicated with each
    adjustment. Conversely, a face to face encounter
    is medically necessary when it is the accepted
    standard of practice in physician offices and
    outpatient clinics, generally because a clinical
    re-evaluation of the patient is also indicated
    (e.g. 24 hours after an initial dose of IM
    antibiotics but not routinely after each
    subsequent dose).

Dressing Changes
  • Dressing changes
  • There may be instances when a caretaker is unable
    to adequately perform dressing changes or where
    the level of complexity of the care requires the
    skills of a nurse. These dressing changes do not
    constitute medically necessary face to face
    visits solely because the service was provided by
    a physician/extender if similar services could be
    provided by nurses or other designated office
    staff. Except in the special case of visiting
    nurse services, medical necessity for a face to
    face encounter is based on
  • The need for a physician/extender to monitor the
    underlying wound at a frequency that does not
    differ from the usual patterns of utilization in
    an office or outpatient clinic OR
  • An exacerbation or complication that would
    trigger an examination in those environments OR
  • Sharp debridement requiring the skills of a

Prescription Services
  • Prescription Services
  • Writing or refilling prescriptions and services
    such as intermittently dispensing medications
    (oral or injectable) to psychiatric patients or
    drug abusers and counting/filling pill dispensers
    for disabled or demented beneficiaries do not
    require a face to face evaluations in the typical
    outpatient setting. Thus the need for a
    prescription refill or medication disbursement
    will not contribute to establishing medical
    necessity for the face to face encounter. These
    are covered services, but are incidental to the
    underlying physician/extender examination and

Pain Management
  • Pain management is a covered RHC service but the
    enabling of a drug addiction (either within or
    outside of a drug rehabilitation program) is not.
    Frequent medication refills for narcotics do not
    represent medically necessary face to face
    encounters, but they nonetheless indicate a
    potential quality of care issue and the overall
    pain management strategy should be well
    documented in the chart. Visits for the injection
    of narcotics usually require an evaluation and
    thus a face to face visit, but they should also
    be part of a well documented pain management
    strategy that includes diagnostic investigations
    and/or pain specialty consultations that attempt
    to minimize addiction and maximize patient well
    being. A pattern of over-utilization of the RHC
    for multiple patients in the absence of pain
    management strategies is not medically necessary
    and additionally may be an indicator of more
    serious problems.

  • Paperwork
  • The paperwork involved in maintaining records,
    documenting encounters for third parties and
    completing forms for patients is an incidental
    part of medical practice. These services (when
    provided in support of an activity not otherwise
    excluded from coverage, such as disability
    examinations) are reimbursed by Medicare through
    the cost report as services incidental to the
    covered encounter. A period of time spent solely
    in record keeping cannot be considered as a face
    to face visit. An actual face to face encounter
    solely for the purpose of creating or filling out
    paperwork is not a medically necessary visit the
    visit must be justified by a medically necessary
    evaluation or treatment.

Recurrent Services
  • Blood Pressure Measurement Follow-up visits to
    monitor blood pressure which include
    physician/extender evaluation and management
    services are appropriately identified as
    encounters. The documentation should reflect the
    performance of these services over and above the
    simple measurement of a blood pressure.
  • The frequency of follow-up is medically necessary
    when consistent with the recommendations of The
    Sixth Report of the Joint National Committee on
    Prevention, Detection, Evaluation and Treatment
    of High Blood Pressure.
  • http//

Recurrent Services
  • Specific medical necessity must be clearly
    documented to support frequencies greater than
  • New diagnosis (first 6 months) lifestyle
    modification monthly (q 30 days)
  • New diagnosis (first 6 months) pharmacological
    management monthly (q 30 days)
  • Established diagnosis lifestyle modification
    controlled quarterly (q 90 days)
  • Established diagnosis pharmacological
    management uncontrolled monthly as long as at
    least every other visit supports active
    intervention (change in therapy)
  • Established diagnosis pharmacological
    management controlled quarterly (q 90 days)

Recurrent Services
  • Accelerated or unstable hypertension with a need
    for rapid control of pressure medically
    necessary as long as each visit supports ongoing
    direct and active intervention (change in
    therapy) during the period of frequent
    follow-up.Visits solely to obtain BP
    measurements are incidental to the primary EM
    visit, and any follow-up at a frequency that is
    not supported by current standards of care is not
    medically necessary.

  • Services related to the terminal illness of a
    hospice patient cannot be billed as RHC services.
    If the RHC physician is the hospice patients
    attending physician, these hospice-related
    services can be reimbursed by the hospice service
    to the physician. RHC physicians and
    practitioners can bill, as an RHC, only the
    services that are not related to the terminal
    condition of a hospice patient

Mental Health
  • The beneficiary is responsible for at least 37.5
    percent of the all-inclusive rate for psychiatric
    therapy services. Additionally, the beneficiary
    is responsible for the coinsurance and any unmet
    deductible (for RHCs only) that is based on the
    remaining 62.5 percent of the reasonable charges.

Mental Health
  • Part 1 - 62.5 limitation
  • 1. Multiply the charges for revenue code 0900 by
  • Part 2 - Deductible and coinsurance calculation
  • 1. Multiply charges for revenue code 0900 by
    62.5 to calculate recognized charges.
  • 2. For RHCs, apply any portion of recognized
    charges necessary toward the deductible, if it is
    applicable and has not yet been fully satisfied.
    For FQHCs, there is no deductible obligation
    therefore, this step is not applicable.
  • 3. Multiply remaining recognized charges by 20
    to calculate coinsurance.
  • Total beneficiary liability for RHCs is 37.5
    percent of revenue code 0900 charges plus 20
    percent of recognized charges (coinsurance) plus
    any unmet deductible (as calculated from
    recognized charges.)

Therapy Services
  • Face to face therapy encounters that are
    uncharacteristically shorter or less intensive
    than their traditional ancillary service
    counterparts (i.e. typically less than 30
    minutes) will be denied as not medically
  • Group therapy sessions are not consistent with a
    traditional physician-patient visit, are
    appropriately treated as incidental (cost report
    reimbursable) services, and are not medically
    necessary for the physician/extender level of
  • Only one-on-one therapy sessions may be treated
    as face to face visits group sessions are
    covered RHC services and are reimbursed through
    the cost report.

Therapy Services
  • Cardiac and Pulmonary rehabilitation (CR/PR) are
    NOT therapies In accordance with the Medicare
    benefit structure, these services must be
    provided incident to physician services in the
    outpatient environment, making them cost report
    reimbursable for the RHC. Based on utilization
    patterns in other outpatient environments, up to
    three physician contacts ("face-to-face visits")
    will be considered medically appropriate to
    monitor the course of cardiac or pulmonary

Chiropractic Services
  • Chiropractic clinics
  • Coverage of chiropractic services is specifically
    limited to treatment by means of manual
    manipulation of the spine for the purpose of
    correcting a subluxation that has been
    demonstrated by x-ray or physical examination.
  • The patient must have a significant health
    problem (neuromusculoskeletal condition)
    necessitating treatment,
  • must have a direct therapeutic relationship to
    the patients condition and provide reasonable
    expectation of recovery or improvement.
  • Once the functional status has remained stable
    for a given condition, further manipulative
    treatment is considered maintenance therapy and
    is not covered.
  • chiropractic care must augment (not replace) the
    primary care nature of the RHC.

Off Site/Other Services
  • Nursing Facilities
  • Home Visits
  • Domiciliary Visits
  • Hospital Visits
  • Hospice Visits
  • Visiting Nurse Services
  • Telehealth Services
  • Family Consultations

Medical Record Requirements
Medical Record Requirements
  • Each page of the medical record must be
    assignable to a specific patient by some form of
    identification, either a complete patient name or
    a unique medical record number.
  • Each face to face encounter documented in the
    medical record must include the date on which the
    encounter occurred or, in the case of multiple
    visits on a single day, the date and time of the
  • Each face to face encounter documented in the
    medical record must end with the signature of the
    provider who personally performed the face to
    face visit.
  • The provider signature may be appended to the
    medical record in any of several formats, but in
    all cases must be sufficiently unique to allow
    both the provider and Riverbend to determine
    unequivocally at a later date that the provider
    personally affixed the signature

AR Management
AR Issues
  • Common Billing Errors
  • Diagnosis Code (ICD-9) problem
  • Beneficiary Name/HIC/Sex are incorrect on claim
  • MSP issue
  • Dates
  • Timely filing

Billing and Collection Processes
  • Tracking all visits
  • Tracking all services
  • Patient collection activities
  • Monitoring payments
  • Appealing denials
  • Non RHC service AR management

AR Management Tips
  • Start from the beginning
  • Entering demographic info- track errors and
    provide feedback
  • Charge entry- check and re-check, trained
    individuals must do this
  • Claims submission- daily duties, follow-up on
    electronic submissions
  • Daily/Monthly AR follow-up routine

AR Management Tips
  • Set production goals/minimum expectations for
    working accounts
  • Review documentation, meet weekly with team to
    discuss payor issues, errors, new policies
  • Track denials, review logs, pinpoint issues
  • Automate your processes as much a possible
    maximize that software!

AR Management Tips
  • Create a system where staff understands these
    concepts and is able to identify issues
  • Create a simple system where you can produce
    statistics easily
  • Report data in a manner that they can easily
  • Set realistic goals with staff involved

AR Management Tips
  • Establish monthly meetings with AR staff
  • Include front desk representative
  • Encourage staff to develop their own solutions
  • Reward success

AR Management Tips
  • Double check demographic data entry
  • Review claims prior to submission
  • Close the loop with payors
  • Verify eligibility and benefits both pre visit
    and retroactively if appropriate
  • Submit claims receive payments electronically

AR Management Tips
  • Talk about AR issues on a routine basis with
    staff and providers
  • Ensure that training is occurring appropriately
  • Involve the front desk in AR performance
  • Collect patient responsibility before they see
    the provider
  • Hire the cream of the crop for your AR team
    keep them happy (but do not make anyone
  • Employ written policies and procedures
  • Outsource tasks when it makes sense

Thank You!
  • For further information or questions
  • Deborah Holzmark
  • Senior Manager
  • Dixon Hughes PLLC
  • (828) 236-5794
Write a Comment
User Comments (0)