Health Care Collector - Kluwer Law International

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PAGE2 EDITORIAL ADVISORY BOARD Chris Becraft President Collection Service Bureau, Inc. Scottsdale, AZ Frederic W. Burr Attorney at Law Senior Partner Burr & Reid, LLP Vestal, NY Kempton S. Smith, CPAM Director, Patient Financial Services Baptist Health System Pensacola, FL Ted M. Smith President Health Services Program ACA International, Inc. Minneapolis, MN Toni Shamblin Manager Summa Health System Accounts Receivable Cuyahoga Falls, OH Linda Thompson Business Officer Manager Mark Reed Hospital McCleary, WA Judy I. Veazie, CPAM Senior Consultant Forum Healthcare Portland, OR EDITOR’S PERSPECTIVE Dear Subscribers, As we usually do in the Health Care Collector , we focus this month on some of the ways that hospitals can avoid losing the dollars that they having coming to them. Hospitals can lose money in a number of ways that are beyond their control, but some of them are at least partially controllable. Contacts in the industry have told us that they have had ongoing problems with writing off costs because of problems with their Advance Beneficiary Notice procedures. This can happen for more than one reason, as you likely know. One patient accounts director tells us how they were losing money due to write-offs and how they made changes to turn that around. We hope that you will find the story interesting and helpful. In the Biller’s Corner, Judy Veazie presents part two of her article about appealing Medicare Advantage plan denials. These plans cover more services than traditional Medicare and there are different rules for appealing claim denials. She explains the different appeals and how they work, including those that beneficiaries can make on their own or with the help of a provider. Included is a flowchart that shows in graphic detail how the appeal process should work. This should work for those of you who want to set up a procedure for your office, keeping in mind that those providers who are contracted with MA plans have no appeal rights (unless they are acting on behalf of a patient). Also in this month’s issue, we look at the amount of receivables delayed in Medical Records. It’s another common problem for hospitals and it can be tough to overcome. We get some advice from one of our editorial advisors about what providers can do about establishing a policy—including teaming with the policy medical staff in developing that policy—to make sure all coding is completed within a specific timeframe. Then, the specific delays can be tracked by physician. As always, we are looking for your comments about these topics. Let us know if these stories are helpful to you and your staff. If there’s a topic that you would like covered, please let us know. Please send your comments to me at jmpeta@aol.com. Best Regards, JoAnn Petaschnick, Editor AUGUST 2010 HEALTH CARE COLLECTOR
Days of Revenue in Medical Records Slides Providers seek to fill gaps F or the third time in as many quarterly financial reporting periods, the average number of days of revenue in the Medical Records department fell. In the first quarter of 2010, the average number of days of revenue held up in Medical Records was reportedly 5.24. This was down from the fourth quarter 2009 figure of 6.39 days. And, the average number of days was also down a tad over the second (6.93 days) and third quarters (6.32 days). See Exhibit 1. Hospitals with 100 to 199 beds responding to the HARA Report on First Quarter 2010 survey indicated 6.70 days of revenue in Medical Records. This was the highest figure reported in the first quarter. Hospitals with zero to 99 beds followed closely with 6.40 days. See Exhibit 2. Facilities with 200 to 399 beds reported only 4.00 days, the lowest figure. And, the larger hospitals with 400 to 699 beds were quite a bit higher at 5.61 days in Medical Records. See Exhibit 2. Reasons for Delays Obviously, patients’ accounts get bogged down in the cycle, but why? Industry consultant Steve Chrapla of Revenue Cycle Partners in Billings, Montana, provides some insight into the problem of Medical Records delays. He offers the following reasons why accounts are delayed: PAGE3 Exhibit 1. Days Revenue in Medical Records—Last Four Quarters 2nd Quarter 2009 3rd Quarter 2009 4th Quarter 2009 1st Quarter 2010 6.93 days 6.32 6.39 5.24 Source: HARA Report on First Quarter 2010 , vol. 24, no. 2, Aspen Publishers, Inc. (2010). Exhibit 2. Days Revenue in Medical Records—By Hospital Bed Size 0–99 Beds 100–199 Beds 200–399 Beds 400–699 Beds 700+ Beds National Average Number of days 6.40 6.70 4.00 5.61 n/a 5.24 Source: HARA Report on First Quarter 2010 , vol. 24, no. 2, Aspen Publishers, Inc. (2010). Health Care Collector © 2010 Aspen Publishers. All Rights Reserved. Editorial Inquiries: JoAnn Petaschnick Phone: 414/545-1150 Fax: 414/545-1255 Email: jmpeta@aol.com To subscribe: call 800/638-8437 For customer service: call 800/234-1660 Publisher Paul Gibson Senior Managing Editor Joanne Mitchell- George Managing Editor Elizabeth Venturo Marketing Director Dom Cervi Health Care Collector (ISSN:1060-0442, USPS: 017746) is published monthly by Aspen Publishers at 76 Ninth Avenue, New York, NY 10011. Postmaster: Send address changes to: Health Care Collector, 7201 McKinney Circle, Frederick, MD 21704. Subscription price: $485 per year plus postage, handling, and appropriate state sales tax. Single issue price: $49. Business and circulation: Fulfillment Operations, Aspen Publishers, 7201 McKinney Circle, Frederick, MD 21704. This material may not be used, published, broadcast, rewritten, copied, redistributed or used to create any derivative works without prior written permission from the publisher. Permission requests: For information on how to obtain permission to reproduce content, please go to the Aspen Publishers Web site at www. aspenpublishers.com/permissions. Purchasing reprints: For customized article reprints, please contact Wright’s Reprints at 1-877-652-5295 or go to the Wright’s Reprints Web site at www.wrightsreprints.com. HEALTH CARE COLLECTOR AUGUST 2010
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