Improving a TPL Billing System

1. Improving a TPL Billing System John Greenawalt, LPC Director of Quality Management TERROS April 12, 2011

2. Tip #1 • Find out where you are: • Are you billing all the services you are providing? • How do you know??? • A non-billed report • Based on the electronic schedule • Or on Super bills, if you are still paper based • Follow some services through your system • Check to see that services are flipped to the secondary insurance once payment is made by the primary.

3. Tip #2 • Ensure that your receipts entered into the system • EOB’s are carefully entered • Client balances are adjusted • Insurance adjustments • Co-pays • Write-offs • (in case you provided a service that is not covered by the TPL) • Follow a payment through your system.

4. Tip #3 • Track your authorizations • Questions: • Who gets them? • Where are they posted? • Who keeps track of them? • At TERROS: coordinate between front office and clinical • Clear communication between front office, clinical and billing staff

5. Tip #4 • Track your denials • These will probably lead to a few common issues that may be improved with training /supervision • For instance: • Not a covered service • Wrong provider provided the service (not in the authorization) • Authorization was expired • Authorization was never requested

6. Tip #5What you need to Find Out • What part, exactly, does each staff play regarding billing & collections? • Appointment staff • Front office staff • Clinical staff • Medical providers • Work up a detailed process flow-chart for each staffing group • Find out how each group touches an aspect of the production / billing / collections systems • Find out where the cracks are • Fill the gaps – work with the staff who do the job

7. Tip #6 • Improve communication: • Between: • Intake and billing • Billing and front office • Front office and appointments (call center at TERROS) • Don’t forget clinical and medical providers! • TERROS developed the “TPL Information Sheet” • A structured monthly meeting with members of each group can be very helpful to ID billing and collection gaps and barriers

8. Tip #7Utilize Technology • Insurance company web portals • Instant and up to date information • Internal Reports • Need real time data to be helpful • External data dumps • EOB’s sent electronically to your system, with auto updates of all accounts • Graph your successes • Watch those lines go up the chart! • Share the information

9. More on Internal Reports • Reports: • Are able to be run by clinician, by site, by TPL in order to ID where the problems are • Can track aging by TPL and by claim • Will detail the ‘denials’ and allow billing staff to make corrections, and re-bill • Will lead you to common errors, that may be fixed by training and supervision

10. Tip #8Payments may come 60-150 days after service provision • Charges are posted on the front end, but payments are usually posted on the back end, so your chart will need some explaining • You can calculate actual percentages of dollars received ($50 collected out of $100 billed = 50%) • Or you can also calculate the ‘expected’ percentage of dollars received ($100 billed, but only $80 is collectible: $50 collected = 63%)

12. A Bit of Progress • When TERROS started this, we were noting a TPL collection rate of 14% • Today, we are noting a collection rate of 70%, of collectible • There is still more work to do.

13. Any Questions? • John Greenawalt - johng@terros.org • Rochelle Green - rochelle.green@chess.wisc.edu • www.NIATx.net • Link to NIATx Billing Guide - http://www.niatx.net/Action/PromisingPractices.aspx • Link to ACTION Campaign II Webinar Library – http://www.niatx.net/Action/WebinarLibrary.aspx • Link to NIATx Blog - http://www.niatx.net/Mediacenter/Blog.aspx?SPNID=34