*Beginning Side Note: I chose the plunger as a pic to start with as it best describes Billing Duties /Tasks associated with insurance companies. You literally will feel as though you are having to plunge the organizations hard earned money right out of the insurance companies greedy-sticky hands. Okay lets get to work on how this is done using Heno Platform.
End of Day Billing Log: FORM LINK Complete this form at the end of each day.
Billing/Collections Tasks by Location: FORM LINK
CHART AUDITS: Should be done on a daily basis & faxed to owner monthly, thus all evaluations for the month must be listed and audited on this form.
Chart Audit Form Print Double Sided & complete Monthly (fax to owner on the last working day of the month).
PAYMENT WORKSHEET: This document that is part of the new pt paperwork is the sole responsibility of your position. The front desk can fill it out initially if they have time, however it must be audited thoroughly by the you & signed off on. If the front desk initially creates the data, then there will be two names/signatures on this document. The accuracy of the data on this document is huge for setting the stage for the patient reimbursement & Loyalty.
WC/AUTO:
Each WC claim must include the claim + the visit documentation. For the Evaluation day the eval + note must be sent with the claim.
For massage these are insurance claims. Print claim in Heno as PT, however white out provider & input the MT Name, NPI#. Mail claim (or fax) with the daily note (and the eval if it is the first visit). Remind MT, daily notes are due that the medical massage is completed.
Specific Wording which must be on WC/AUTO Claims to avoid Denials: WC/AUTO documentation must state (copy & paste to notes as needed) :
1) Time was spent Direct one-on-one patient contact 2) This may not be comprehensive. Contact us for the original note. 3) Unless otherwise noted, all time-based codes are in 15 minute increments & total time spent is 60 minutes. 4) Body Part(s) treated is specifically related to ICD 10 code as listed.
Submit Claims Daily:
Clean Claims: this is when the claim has all areas checked off and gets the green light. Map for Process for Assessing Clean Claims:
Go to Encounters Tab- check each claim for auth if needed- if auth is needed and it is not there then make sure auth was submitted. Below is an example of a encounter where the status is Waiting on Auth while awaiting auth (common for Aloha Care, Ohana, MDX for HI) and (REGIS for ID) . This is normal to do for the eval until auth is secured. Remember to make sure auth is submitted same day as EVAL. or we risk non payment.
Billing CPT Code Modifiers: Heno should catch these and input them automatically. This does not always happen. Here the are the common ones to look for: For Example when 97140 and 97530 are used in the same visit the “59” modifier must go in with cpt code 97530. The Green side is where the “59” modifier is inputted. Cheat Sheet:
EDI TAB: (daily) : clear daily all non rejected claims.
Heno Statements:
(copy & paste #1) Arrange payment to avoid interest and penalties that may be applied to your account.
(copy & paste #2) Your account is past Due. Once again, to avoid further penalties payment must be made by INPUT DUE DATE .
Collections:
When sending out collection statements for pt portions input that data into Notice Prep Statements box and date notice statement was sent with past due notice I also like to be as detailed as possible, this example does not show it but I will put this info of amount due etc so if pt contacts us we can easily provide them this info with EOR uploaded to pts account etc. . When payment comes in, apply payment to pts account and then input a note that this was received dated per below example. Make sure to do this or there is the change that the pt will be billed again & then there will be an angry phone call coming your way. Complete collections along with chart auditing ie; during chart auditing you note that a pt had a deductable that was not collected on etc.
Heno Statements & Past Due Letter(s) – SENT TOGETHER:
follow these steps to create a statement on Heno: https://heno-support.helpscoutdocs.com/article/110-how-to-make-generate-statements
include with the statement a past due letter per below:
past due letter (s) – sent 2 weeks between each other.
Past Due Notice Template 1 (Kauai)
Past Due Notice Template (Idaho)
(copy & paste #1) Arrange payment to avoid interest and penalties that may be applied to your account.
(copy & paste #2) Your account is past Due. Once again, to avoid further penalties payment must be made by INPUT DUE DATE .
PART 2
EDI (Electronic Data Interchange)
This is where claims are sent out to the billing clearing house (office ally). From there the claims are either rejected for various reasons (sometimes you have to investigate & find out why) -or- the claim is accepted at the clearinghouse and from there sent out to the insurance company for reimbursement. Think of it this way- the claim is like an amazon order and the clearinghouse is Amazon. Either Amazon gets the order successfully (the cc info you provided was correct, the order is in stock, etc and then mailed to you) or the order is rejected for various reasons and the order is rejected. The EDI area on Heno is like the email you receive from Amazon letting you know the order was rejected.
EDI STATUS on Left hand menu:
The RED is what you need to be alerted too so you can immediatly INVESTIGATE the reason, FIX, then REBILL. Keep your eyes on this area on Heno and check several times during the day for quick rebills.
Not sure of the rejection reason? Ask Mindy, I am certain she has seen it before! Then keep written track of each reason code and you will devise your own cheat sheet of denial codes for quick Rebills. Here is an awesome list of rejected claim codes for you.
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Notifications:
It is critical to document what has been done. You will find this out when auditing a chart, or simple to find out what is going on with pts reimbursements, collections, etc.. It will read like a story and is highly valuable. This is done in Enter Details, When scheduling (will show up when scheduling pt), On Encounters (an Encounter is what a claim is before it becomes a claim – think a tadpole vs a frog), A claim, Notice when Posting, and Pt statements (this one is done when you have sent out a collection letter to pt for collection on pt portions). When documenting, it should read with the most recent notification on top (first) with the later notifications to follow. Follow ups need to be documented with initials (of the author) and date created. More detailed Info – CLICK ME
Follow Ups:
This is used to show up each day with each days tasks. They may be to collect a pt payment, secure authorization, follow up on a pt checking their schedule prior to scheduling, etc. Follow ups need to be documented with initials (of author) and date. These will disappear when each day and thus need to be copied and pasted to fitting area in Notifications. These can be commonly created by front desk staff, billing , and owner. You will like this organized system in order to keep yourself and others informed & follow through on tasks for each chart. These must be zero by the end of each day.
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The GRAND No Response Claims (bottom R of Heno Dashboard:
Oh my gosh this is critical in order to keep your AR (accounts receivable) down, keep denials down, pt collections- collected, insurance reimbursements in, and the successfully closed charts. If a claim has not been paid by the insurance company after 21 days, then it becomes a No Response Claim & Must be Investigated in order to Rebill and successful secure reimbursement. Bottom Right of Dashboard, it says 1,725 claims, that is not acceptable and a problem we must attack and keep a low #!
How do we do this? Start at todays date (Timely Filing Law only allows us 1 year to collect on un-billed claims) If you start on todays date you can possible collect on monies that otherwise may not be collected. In order to audit claims, you must have a good eye for detail and investigate why a claim was not paid upon and re bill if needed, correct case (ie incorrect insurance info was inputted) , authorization dates or # was incorrect, or contact insurance company if you are unable to find a reason.
Applying & Posting:
To apply Workmans Comp Claims that go through : CORVEL CLICK HERE for Directions PDF
HENO help desk and the staff!
We pay these guys loads of money- USE them for help and training. Schedule your one on one training, have your questions ready -super useful and informative! For quick questions- use Support Email system <support@heno.io> these guys are great at getting back in a timely (same day) in most cases. This gal knows her stuff: Jania Myers-West Email: Support@heno.io
Help Area:
Bottom top bar in Heno – Click HELP and it will take you here for tons of great training/learning/resources:
Click here for some great tutorials.
Awesome Simple Resource on Billing : https://www.verywellhealth.com/insurance-claims-denial-2317138
