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ASSUMED:
You have done this product before with this insurance carrier.
If you are not 125% sure, call.
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STEPS:
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| 1. |
If you
are comfortable that the product is covered for the patients
carrier and diagnosis you dispense product only after you obtain
the information on a NEW PATIENT CID (click
for a sample).
Obtain the PATIENT ASSIGNMENT OF BENEFIT / FINANCIAL RESPONSIBILITY
form (sample). On an existing
patient, just record the patient, date and product dispensed.
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| 2. |
Batch
the patients you delivered items to. Use a stack tray or hot
file for "DELIVERIES".
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| 3. |
Take the
batched deliveries for all patients that week and send everything
to Integrated. Note on the document the person and date who sent
it to Integrated. Remember, we believe you, so don't send us documents we don't
need please.
Did we mention that we would prefer if you would enter your information
via the internet?
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| 4. |
Take the
processed deliveries once sent to Integrated and put them in
a stack tray or hot file for "ENTERED" which will include EVERYTHING you
sent Integrated during the calendar period. This is important,
don't file anything away just yet.
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| 5. |
When you
receive EOMB's, they should also be placed in the "DELIVERIES" stack try. Eventually
those EOMB's will be sent to Integrated and moved to the "ENTERED" file. Denials should
be faxed right away and moved straight to the "ENTERED" stack tray.
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| 6. |
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When you
receive your MONTH END REPORT PACKAGE from Integrated (sample) determine that every patient sent
 to
Integrated for billing is on the month end report. The month end report
shows all claims that "went out the door". If you find
a claim sent to Integrated is not on the report it's because
it was not received or was unable to be billed. The ones that
did not get billed should not be filed away yet. However all
those documents from the "ENTERED" stack tray that where generated
and are on the report can now be safely filed. There are many
reasons why claims you send us do not get billed. If you detect
a missing patient please contact us.
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| 7. |
 Big three-ring binders are great for keeping
track of the billed claims. Filing cabinets too, but a three-ring
binder with A to Z tabs filled with your past documents give
you a portable audit trail. When you wonder if something can
be billed, open the binder and look what was done before. Our
month end reports should also be kept together in a data binder
or file for the same reason. The month end report shows the patient's
carriers, previous products billed, and billing amount. You can
figure out the 20 percent copayment for the reports.
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| 8. |
If you
review your EOMB's for payment, go to the month end report to
note payment received and patient portions due you. Integrated
recommendeds color coding the month end report, yellow highlighter
for paid in full, pink for patients that owe you money for copayments
and deductibles. As time permits you then use the report to generate
the patient statement for copay and deductible charges. When
you do that have the person creating the patient statement record
the date it was billed on the report. When you receive the patient's
payment go back to the report and note that. You have two valuable
tools then; the binder with the CID's, and the month end reports
with notations as what was paid, what was billed to the patients,
what products are covered by carrier and what products you consume
monthly for purchasing.
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| 9. |
One of
the reports at the end of the month will identify all the products
billed. This report is useful in managing your product. If you
consumed 46 boxes of strips last month you will likely need at
least that many again next month. If you can buy 100 and get
a better deal, then you know that by ordering 100 boxes you will
have a 2 month supply at a better price than if you just bought
what you needed for a single month.
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