Chandresh Shah

Billing Challenges to stay independent

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Patti Van Zuuk is VP or Revenue Cycle Management. She manages over 68 practices and has a team of 107 at the time of this interview.


Biggest Challenge Small Practices Face with their Billing

CHANDRESH: When you talk to your clients, what is the biggest challenge small practices face with their in-house billing?

PATTI:  I think there are two. One, they are not acting as a business- the doctors not involved at all with regards to finances. They think they went to school for medicine and they focus on medicine and of course somebody else has their interest at heart. If provider is not checking, 9/10 times, none of this will happen.


CHANDRESH: Why are the providers not checking?

PATTI: They’ve been taught through medical school that what they should focus on is medicine and they assume that they’re going to hire this person that is going to focus on the financial side. But that’s not the case, the provider is a business owner and should be acting like a business owner. And not to say that the provider themselves have to be the checker but somebody does.


What should a good biller do?

 CHANDRESH: What does the good biller do to keep current with the codes and modifiers?

PATTI: Keeping current by signing up for all the CMS updates, using ‘super coder’ that gives you CMS updates; it’s a yearly subscription and you can also log in anytime and ask questions.

CHANDRESH: Is that a community?

PATTI: It is a community


What causes reimbursement to go down?

 CHANDRESH: The other question, some doctors always complain that reimbursements is down.

PATTI:  In some cases, reimbursements are down but not really enough to affect providers but 99% of the time it’s about coding and modifiers. Reimbursements went down as an example for balloon sinuplasty for 2018 but there’s a better code to be used, providers and billers just need to be educated to use those codes,


CHANDRESH: So as an extension of that, have you come across providers leaving their practices and joining hospitals? I talked to a few doctors and they say it’s because reimbursements are down and patient responsibility is high and patients are not paying.

PATTI: So basically, this is disfunction. I would say to any provider that tells me reimbursements are down and patient responsibility is up – I would take a look at their A/R because I would say most of what’s being lost is in the A/R. Their front office should be educated on how to collect money from patients prior to visits. I would bet that there’s a lot of money laying in A/R.


How to keep practice financially healthy

 CHANDRESH: That answer my next question, what would you advise them to keep their practice financially healthy in addition to what you just said, is there anything else?

PATTI: Proper education on what each department is responsible for.

CHANDRESH: Assuming that they have a good billing person and office manager, what should provider be asking and reviewing with their biller on a weekly basis?

PATTI: I always say from 10,00 feet, it should be charges, revenue and A/R. They should also review schedule against charges to make sure everything is being captured and charges against revenue to make sure they’re being paid completely on what they are contracted at and A/R to make sure there’s nothing laying in there.


How important are rejection rate and denial rate?

 CHANDRESH: How important are the rejection rate and the denial rate?

PATTI: Denials not so much. Denials are insurance companies asking for information. Rejections are very important, generally they are about patient demographics, whether it is their insurance or actual demographic and that needs to be corrected right away.


How important are front desk people in a practice?

 CHANDRESH: When it comes to billing and collections, what role does front desk play and how important is it?

PATTI: They’re the most important person in the medical office. They can make or break a practice, they are more important than the billers because if the front desk does what they are supposed to be doing, the biller really doesn’t have to do that much at all. The front desk collects correct information, make sure the patient is eligible, all the biller has to do is create the claim and off it goes.


What information should front desk collect?

CHANDRESH: What information should front desk collect?

PATTI: They should collect demographic information, insurance information, check eligibility to make sure that patient is eligible and patient responsibility.

Chandresh: I’m assuming that we should check and verify every visit.

Patti: Yes, insurance can change every 30 days