Tag: Billing

16 Apr 2016

10 considerations to avoid billing disruption during a physician group merger


There are several things consider to avoid disrupting billing when two physician groups come together. Here are a few to consider:

1) Identify list of insurances that the combined entity would accept.

2) Determine credentialing timelines for top 5 insurance companies. For example, Medicare takes 90-120 days, BCBS takes 45 days, United Healthcare/ Oxford takes 60-120 days and so on. This sets the timeline for the billing start date through the combined entity.

3) Determine billing data and system setup timelines. Consider the following:

  • practice management system setup
  • receiving a submitter ID from the clearinghouse
  • setting EDI/ ERAs
  • establishing HL7 connection between systems (if needed) and any data migration needs

4) Determine risks during credentialing with commercial carriers. For example, certain carriers tend to automatically delist providers from the previous Tax ID after enrolling with the new one. This may not always be what is wanted (e.g. providers could still serve in the ASC that is associated with the older Tax ID).

5) Consider secondary providers and their credentialing. Would you billing for nurse practitioners? Are there pathologists or anesthesiologists to consider?

6) Would the new entity use a common lockbox? If so which group’s bank to use?

7) Who would be the managing employees and authorized officials of the combined entity?

8) Determine common patient financial policies that would include:

  • common consent forms
  • number reminders to be sent before sending patients to collections
  • default payment plan
  • mode in which payments would be accepted
  • Write-off and billing policy for non-participating insurance plans
  • No-show and cancellation charges

9) Determine a common insurance refund policy. Would it be immediate or as payments occur?

10) Determine access controls for financial and administrative reports of the combined entity.

09 Apr 2016

5 Things to look for when reviewing billing of a surgery center

When I review billing of an ambulatory surgery center, here’s what I mainly look for and it usually gives me enough clues to what I need to know.

1) Are there unbilled charges from more than a month ago?

2) How many denials show up in the EOBs received from Medicare and BlueCross for the previous week? I tend to review ALL the EOBs.

3) What’s the comparison of new patients to existing patients over the past year? What types of insurances do they represent?

4) How does the Accounts Receivable Master look? How many high-dollar claims (e.g. above $1,000) are untouched – over 90 days, 120 days and so on?

5) When were the contracts last updated?

There are several other things that I could look for and I do but at the outset am looking for a feel of how a center is doing. Answering these five questions usually provides me with a direction to probe more. I supplement these with interviews with staff. Another important activity that I do is to simply sit by the front desk and observe patient flow and work flow through the day – sometimes for several minutes at a stretch.

Taking the above steps, we turned around a gastroenterology center at one of the major hospitals in New York.

By Praveen Suthrum, President & Co-Founder, NextServices.
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