Payer-Physician Relationships – The Key to Smooth Reimbursement

medical billing tips

Practices and providers know how important the patient-physician relationship is, but to stay in business, medical billing professionals must also pay attention to the relationship between the payer and the provider. The better the relationship you have with your payer, the more likely you are to have smooth claims processing and revenue for your work.

Communicate and Document

Today, executives with financial backgrounds usually run payers, so a clinician will not necessarily review your claims. If you’re having problems with your payer contract, first check in with the payer’s contract management representative or team. Document every conversation you have with that team so you can keep track of all communication.

Associate, Even If You Stay Independent

Even for smaller providers, it can be helpful to be part of a practice association, which allows providers to benefit from economies of scale with purchasing and other practice necessities. Independent practice associations can have different purposes and goals, including negotiating managed care contracts or accountable care organizations. Practice associations also allow cost sharing to reduce expenses such as administrative overhead. When you consider joining a practice association, make sure you have a health attorney review any documents before signing them, to avoid violating Stark law or anti-kickback statutes relevant in your state.

Four Tasks for Your Technology

Medical billing produces never-ending paperwork, so a good automated system is key. Ensure that yours can handle these features:

  1. Acquires and stores electronic medical records electronically in a central database
  2. Retrieves patient demographic information from your hospital registration system
  3. Submits electronically to Medicare, Medicaid, and other third parties that receive electronic claims
  4. Handles electronic funds transfers with third parties to deposit funds directly in the practice bank account.

Use a Personal Touch

Business relationships are built on professionalism and courtesy, so develop a good rapport with the people who work at the third-party payer agencies. Your practice will probably work with the same people over and over, so keeping a positive relationship with them from the start will pay off.

Understand the Alphabet Soup of NCDs and LCDs

Medicare contractors develop local coverage determinations (LCDs) for their jurisdictions when no national coverage determination (NCD) exists. For this reason, it’s important to check both NCDs and LCDs before you bill for a particular service. Most coverage is determined on a local level by clinicians at the Medicare Administrative Contractors (MAC) offices that pay claims for Medicare services, so you’re most likely to encounter LCDs when billing. However, sometimes Medicare develops an NCD for particular items or services. NCDs are national policies that come from evidence-based determinations that a particular item or service is reasonable and necessary. The public may request an NCD, or CMS may itself decide that one is needed, with consultation with the Medicare evidence development and coverage advisory committee, or MEDCAC. For example, a July 22 MEDCAC meeting looked at scientific evidence of interventions that improve health outcomes in lower extremity peripheral artery disease.

What Medical Billing Tips Can You Share?

Our SuperCoder users are experts, too, so we love to share their thoughts and tips. Do you have any ideas about good medical billing practices that you’d like to share with us? Let us know in the comments box below!

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Susan taught health information and healthcare documentation at the community college level for more than 20 years. She has a special love for medical language and terminology. She is passionate about ensuring accurate patient healthcare documentation through education. She has a master's degree in healthcare administration, is a certified healthcare documentation specialist, and serves as immediate past president for the Association for Healthcare Documentation Integrity (AHDI).

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