This happened to us and our ‘work around’ was to have a 3 to 7 day lag time
(depending on the hospital) between the time the service is done and we are
sent the electronic data file for the service. Having worked in the
hospital prior to coming over to the provider billing side, I can tell you
many hospitals may ‘gather’ the new/updated patient information when the
patient checks in for their service but the hospital system, where we pull
the billing info from, is not updated until after the services are
completed. Many times, 1, 2, or 3 or more days after the service. Having a
lag time helps reduce inaccuracies in the billing information because it
gives the hospital time to update/complete their information.
Although not 100% perfect by any stretch of the imagination, it has helped
considerably.
I do not like to wait 3-7 days for the information in order to bill, but it
actually saves time on the back-end if we are getting more correct/complete
information to begin with.
If you are already doing this, then I would suggest speaking with your
providers and set up a meeting with hospital administration to discuss.
Julie
Julie Harman, RN, RCC, CPC, CIRCC
Director of Operations
Professional Management, Inc.
6915 Chancellor Dr.
Cedar Falls, IA 50613
<mailto:
jharman@pmimedbill.com>
jharman@pmimedbill.comOffice: 319-260-2101
Fax: 319-260-2102
Cell: 319-240-2028
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Original Message------
I work for a hospital based radiology group, and we rely on the hospital to provide us with patient insurance information. We are receiving excessive denials for eligibility reasons. Our current billing company submits 270 transactions (health care eligibility benefit inquiries) directly to the insurance carrier. Unfortunately the 271 responses have not provided us with the necessary information to rebill, resulting in a low success rate.
What eligibility checks is your billing company/staff utilizing?
Do you feel this process is providing you with necessary insurance information to file?
What is the approximate cost for these eligible check products or How can I estimate the cost?
If you outsource your billing, Does your billing company provide this service within your billing service contract rate?
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Jammia Shea
Medical Center Radiologists, Inc.
Virginia Beach VA
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