5 Steps to More Revenue

Jim Blakeman points out 5 steps to claim more revenue

Practical Ways You Can Rightly Claim the Cash

James R. Blakeman's principles of proper billing include understanding how the payment system weighs your cases, how well you chart them to document and back up your work, and how effectively you translate them to the payers' language of coding. Combined with the specifics and the rules, and correctly applied, these principles can pay off big. Here are some of the top gains you can make:

1. Rightly value the three moderate-to-high levels of care - the single most important factor in increasing collections.

Make sure coders are appropriately using 99283s, 99284s, and 99285s and remember that identifying them is not as easy as it might appear. The key lies in how payers value the risk of the presenting problem and how medical decision- making can be quantified in a chart. Variances in these levels will shift payments by as much as 15 percent to 20 percent.

2. Thoroughly document your decision-making. Along with lab results and diagnostic studies, record why you ordered them and, more importantly, what they don't tell you.

Normal or equivocal results can be much more complicated to evaluate than the obvious abnormal. Don't lose money by leaving your coders in the dark or by leaving your reasons to a reviewer's interpretation. Your private attendings will appreciate the explanations, and your chart will be unassailable if it covers the diagnostic differentials you know best as an emergency care-giver.

3. Don't overlook the value of observation, even when the patient is being sent home.

When time is the principal diagnostic tool - as it is with serial exams or studies (such as cardiac labs or multiple nebulizer treatments) or overdoses that need to be cleared neurologically - you save everyone money and trouble if you are able to eliminate an admission. Claiming that value can add $2 to $5 per visit to your annual net cash collection.

4. Strengthen your case in critical care.

What counts is the high probability that a patient might crash - not the certainty they already have crashed. Your intervention is what critical-care payment is all about. Like observation, correctly claiming this one also gives you the $2 to $5 payoff - which for a 20,000 visit ED can mean $40,000 to $100,000 a year.

5. Learn how to negotiate for your share of the work of interpreting x-rays and EKGs.

You can bargain with your hospital, your radiologists and your EKG readers (and break the monopoly on them!) when you learn how the payment system views the contemporaneous interpretation of these valuable emergency services. Case studies in the Annals of Emergency Medicine show that even studies billed only after hours can represent $4 to $ 8 per patient.

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