What's on it
Work through each check with your biller or your own reports. Every box you can't tick is a place money may be slipping.
Case capture
- Every case on the facility schedule has a matching claim
- Anesthesia records arrive within a day or two of the case
- Cancelled and add-on cases are tracked, not lost
Time and units
- Start and stop times are recorded on every record
- Breaks in care are recorded and only care time is billed
- Time is counted the way each payer requires
- Block time placed during anesthesia is not double counted
Coding and modifiers
- Anesthesia codes match the operative note, not the schedule
- Staffing modifiers (QZ, QX, QK, QY, AA, AD) match how each case was staffed
- MAC cases carry QS, and G8 or G9 where they apply
- Physical status is billed to payers that pay it
- Qualifying circumstances are billed to payers that pay them
- Arterial lines, central lines and post-op blocks are captured when done
Claims and denials
- Eligibility is checked before or soon after the case
- Most claims go out within a few days of the case
- Every denial is worked, and the top causes are fixed at the source
- No claim is close to its timely filing limit without action
Payments
- Payments are posted promptly and matched to claims
- Payments are compared with contracted rates to catch underpayments
- Secondary insurance is billed after the primary pays
Enrollment and compliance
- Every provider is enrolled and reassigned with every payer you bill
- Licence, certification and revalidation dates are tracked
- Medical direction documentation is complete for care-team cases
- A sample of cases is audited every quarter
Reporting
- You receive a monthly report with net collection rate, days in A/R and denial rate
- You can see A/R by age and by payer
- Someone can explain every claim over 90 days old