NI-ARLY 28 YHARS OI HILLINCi AND COLLIXTING FROM INSUR-ance companies have taught me a few secrets. Despite the inevitable moaning and groaning that occurs around the thought of insurance billing, the process is actually very straightforward, with rules, regulations, and systems that can be your friend. Like any repetitive process, the development of an internal system brings stability and order to your standard operating procedure (SOP). A strong SOP, coupled with the subtle and passive system described here, will ensure that your relationships with insurers are healthy, productive, and profitable. I have learned to make this system my roadmap to success. Make your personal system about the following 4P's and watch your confidence, productivity, and collections grow. Passion One definition of passion is, "an extreme or inordinate desire." Not really top of mind when thinking about billing insurance, huh? Doctors often wish that they could "just be a cash practice" and not deal with third-party reimbursement. Surveys say 78% of patients with insurance want to use it at their doctor's office. Narrowing your target market to the other 22% could be detrimental to your practice. CA's have been known to beat their head against the walls after long and unproductive phone calls with carriers. It could seem impossible to develop a passion for working with insurance companies. But it is possible! Our purpose in accepting insurance is often to better serve our patients. Because 78% of them prefer to use insurance and have us accept assignment, our doing so allows them to focus on getting better without the burden of upfront, out of pocket costs. Tony Robbins has said that passion is the genesis of genius. Let your passion be the fuel for new ideas on how to do it better, faster, smarter. We know that passion is energy. I call it, "Fake it till you make it." Build on small wins with carriers along the way to give you the motivation to continue. Find out which part you love. Maybe it's appealing and winning; or unraveling the mystery of how to get a new code accepted and paid. Tip: Keep a rolodex or file with the names and extensions of particularly helpful or passionate customer service representatives, so you can ask for them again. Feel the power that comes from focusing on what excites you. That passion will breed new energy and renewed effort to master Medicare or debug a denied claim. Performance Performance is defined as the act of performing: the carrying into execution or action; achievement and accomplishment. To be successful when dealing with third-party payers, the key is to be exact. Because there are rules, regulations, and policies associated with having a third-party pay a patient's bill, in order to master the art of reimbursement, we must also master the science of billing. This includes speaking their language, which we call coding. Whether diagnosis or procedure codes, if we do not adequately describe our work in a format they require, we can't blame them for not paying us. Precision communication with third-parties is critical. We must become experts in using those communication lines to our advantage. This includes properly verifying benefits, understanding contract limitations, being aware of agreements made in provider contracts, and proper execution when submitting bills for payment. For example, if you perform manual therapy on the patient in a separate body region from where you've adjusted the spine, the billing requires a modifier, 59. This proper billing execu- tion says you have billed it correctly and compliantly and nothing should stand in the way of being paid. Nike said it best: "Just Do It!" Learn what it takes to execute perfectly when billing, using precise codes, exact guidelines and just the right amount of audacity and then assume your payment will be forthcoming. Efficiency of each individual performance is what wins the game for the team. Patience Patience has been defined as the state or quality of being patient; the power of suffering with fortitude; uncomplaining endurance of evils or wrongs; the act or power of calmly or contentedly waiting for something due or hoped for; forbearance. If we didn't possess these qualities when dealing with third-party payers, we would lose our minds. Sometimes, it can seem that it's us against them or that their job is to keep our money and our job is to squeeze every dime out of them. Remember, they really are live people on the other end. They have a job to do, just like we do. Because you get more flies with honey than with vinegar, being patient and understanding, within normal limits, can go a long way. One sure way to accommodate patience is to be right on top of every promise they make. The best way to accomplish this is with a tickler reminder file. Any time someone agrees to call you back, make payment by a certain date, or have an answer for you, place a reminder in your electronic or paper tickler file. Checking it every day ensures that nothing will fall through the cracks. Elbert Hubbard said, "How many a man has thrown up his hands at a time when a little more effort, a little more patience would have achieved success?" Outlasting the competition, in this case the third-party payer, is a must. Make it a personal mission to get paid properly and quickly when working on behalf of your patient. Set your reminders, answer every request, and even patiently wait on hold if necessary. Remember the famous words of Benjamin Franklin: "'He that can have patience can have what he will!" Perseverance Perseverance defined is persistence in anything undertaken; the continued pursuit or prosecution of any business or enterprise begun. I do not think there is any other quality so essential to success in dealing with third-party payers than the quality of perseverance. It can overcome almost anything. Jack C'anfield likes to say, "If you don't ask, you don't get." I think this is another way to describe perseverance. I have achieved unbelievable results when simply being the squeaky wheel. Particularly with third-party payers that have an individual assigned to paying your bill, such as a personal injury or workers compensation claim, you may have better luck because of the human element. Even if they ask you five times for what seems like the same thing, don't give up or get frustrated. Eventually, the right side always wins. Having the best documentation, the clearest communication, and the best system will prevail. If you must jump over that hurdle, slide under the bar, shimmy on your belly through the obstacle course and then swim across the river to get your claim paid, it will be worth it in the end. because your patient may have been able to get more care because of it. Each victory that you achieve builds your foundation of knowledge and power so that the next time you are up against any dilemma with a third-party payer, you can pull from this arsenal of information and achieve your desired results. Walter Elliott said that perseverance is not a long race; it is many short races one after the other. I like to say there is no balance like a zero balance. The endgame for any third party claim presented for payment within the boundaries of policy guidelines should always be a zero balance. Don't give up until you reach that Nirvana. Another way to look at these 4P's is that they stand for attitude. Your attitude when you approach a third-party payer is king. It's your choice whether it's easy or whether it's hard. Proper systems and knowledge, together with a mix of passion, performance, patience, and perseverance is the recipe for success when dealing with third-party payers. Kathy Mills Chung is the President and CEO of KMC University, a consulting and training company in the areas of Medicare, collections, documentation, coding, hilling, patient finances, and audit protection. Kalhy is also a sought-after speaker, and can he found delivering seminars at the most important events in the chiropractic field around the country. She can he reached at info(a kincuniversily.com or through www.kmcuniversity.com.EQ]
