Back in the late 90’s, New York State’s Worker’s Compensation plan announced that they were changing pay rates on most services provided to workers throughout the state. I went to a meeting about a week afterwards where people were discussing the problems they believed were coming, and wondering how they were going to submit claims.

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I said I was going to continue mailing out bills as if nothing had changed. Some of them thought that sounded strange, and asked if I wasn’t worried about getting paid properly. I said that if I noticed something drastically out of whack that I would question it, but overall, as long as we were getting paid, that was the most important thing to me.

What ended up happening is a lot of hospitals in the area held onto their compensation bills for months, waiting for more information on the upcoming changes. It affected their cash flow, but they all figured they would make it up on the back end. At my hospital, cash flow was never interrupted and, as it turned out, the state’s changes were miniscule, which means everyone else was worrying about things that meant nothing when it came to submitting claims.

In the late 2000’s, the same type of discussion came up during the period that Congress was discussing the Affordable Care Act program. Meetings I was participating in locally started having the same conversations we’d had 10 years previous. Many of the people in the room worried about their bills and what would be expected of them. Some even said they were going to hold their bills “if” it were enacted until they knew more about the process.

What most people didn’t consider was prior precedent. When both Medicare and Medicaid were introduced, hospital billing departments had to figure out ways of getting claims out the door. Back then, there weren’t many worries on sending bills to insurance carriers. Almost everything went directly to the patient. Suddenly you had these government mandates, and you had to send claims out to someone else. There was panic at the time, and in my mind there didn’t need to be.

As medical billing people, the job is always to get the bills out the door. Whether you bill electronically or on paper, sending out bills is the singular purpose of specific people or systems. Working claims on the back end is the singular purpose of other people. I’m not saying some people don’t do both, but they wear different hats depending on the job they’re doing at the time.

A well run business office has processes for both the front end and the back end. Processes are what makes things go as smoothly as possible. Processes are what takes something new and integrates it seamlessly into procedures already in place. Even if there are slight variations on the information that’s needed, or how the information is sent, if those processes are in place then these are just minor irritations that shouldn’t give much long term consternation.

Whether I was a permanent employee or a consultant, I’ve always advocated for being proactive instead of stagnant or petrified, worried about making mistakes when it comes to billing processes. In the age we’re in, there are inherently more problems created for medical entities by NOT sending bills out as opposed to sending them and seeing what happens… as long as you know the rules. If you’re trying to force through a bill to Medicare that’s 3 years old, you know better. If you’re not sure what they’ll pay on certain services but everything looks correct, it’s better to send it out and see what happens; it just might get paid.

It behooves everyone to shore up their processes and procedures on a regular basis. Make sure there are written processes for getting claims out the door. Make sure there are written processes for how to follow up on unpaid claims. Make sure you’re tracking cash so you can see if there are blips in payments, and whether those blips are natural (following 60 days of less revenue) or unnatural, and act accordingly.

Finally, make sure everyone is trained properly, and as thoroughly as possible. If you have all of these things already in place, then you can weather a little thing like insurance changes. Trust me, we always do.
 

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