Workers' Comp Payments
Q: What law states when a workers comp payments is received than the insurance payment must be refunded?
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Establishing a Central Business Office
Q: Do you have suggestions as to the best way to establish this CBO? Are there other organizations like ours with a CBO structure that you could refer me to for advise?
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Salary Expectation for Director of PFS
Q: I am considering combining my Director of Patient Access and Director of Patient Accounts into one position and renaming the position Director of Patient Financial Services. What level of salary should we provide?
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Best Practice Providers in Michigan
Q: I want to find a hospital in Michigan that is meeting/exceeding benchmark AR days so I can learn from them. How do I go about finding out who these hospitals would be?
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Industry Target for Denials
Q: Are there any industry targets related to denials?
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Low-Dollar Credit-Balance Write-Off
Q: I’m aware of a few providers that adjust low dollar credit balances to a small dollar adjustment, but we’ve been leery of doing that practice. Do you know whether that’s a common practice and if so what’s a typical low-dollar credit-balance write-off?
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Changes in the Denials Management Process
Q: Can you tell me whether/how the economy is driving changes in the denials management process…particularly as it relates to preventing write-offs?
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COB Rejection Statistics
Q: I am looking for any statistics (national trends) related to COB rejections, such as:
- % of claims rejected due to COB related issues
- Estimated staff time to resolve a COB claim rejection
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IV/Infusion Charge in Oncology Departments
Q: Our Oncology Department is presently not charging for the IV/Infusion charge when they administer “anti-emetic” drugs that are given on a routine basis to all patients prior to their chemo treatment as ordered by the doctor. It appears that other area hospitals are billing for this.
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Tricare Claims
Q: I am looking to find cost to collect data by payer type. HARA provides cost to collect statistics; however, I cannot get to the detail I am looking for. For example, what is the cost to collect Tricare claims verses commercial or motor vehicle?
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Private practice fiscal management information, models, and resources
Q: I am new to the healthcare finance field, having previously been the CFO of a social service organization. I am the new Finance Director for an independent non-profit primary care medical practice (about 10 physicians and 20 Nurse Practitioners) located in urban Boston. It is an adult practice and includes no specialties. Our revenue streams are the following: 1) Fee for service Medicare, Medicaid, insurance plans, private payers; 2) Capitation contracts for nursing home and house calls; 3) Contracts to provide medical direction for nursing homes; 4) Some hospital rounding payments; and 5) very limited fundraising and grants. Can anyone point me in the right direction for private practice fiscal management information, models, resources, etc.?
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Common Payment Methods - Ambulatory Surgery Centers
Q: Please describe common payment methods by commercial payers to the Ambulatory Surgery Centers?
I am aware of negotiated per-diem rates. What are other common payment methods?
Percent of billed charges?
Other fixed/bundled payment?
Are Medicare ASC payments typically used as baseline?
What are most typical reimbursement methods?
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Recovery Charges
Q: We’re currently switching our billing system to McKesson Paragon. There’s an issue with the OR module automatically dropping a recovery charge to bill (drops the OR/Anesthesia charge automatically) so the suggestion has been to roll this all up to the OR charge. In other words, make us whole with the charge but eliminate rev code 710. It seems to me that the major hospitals in the Boston area all have recovery charges on their charge masters, and so I’m worried about just eliminating. I realize that for most claims, we’re paid on the surgical code, so may not be an issue---but I’m still concerned with eliminating this charge all together.
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CPT Codes
Q: I am attempting to assist one of my customers with their reimbursement questions. They send patients home on a pump for chemo. They are wanting to get the dollar reimbursement information for several CPT codes. They are:
- Pump and supplies E0781
- infusion 96416
- hick pick code A4222
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Wyoming Medical Records
Q: How long does a clinic have to keep medical records in the state of Wyoming?
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Staffing Benchmarks
Q: I am looking for staffing benchmarks for the Patient Accounting area:
# of accounts/per FTE
# of hours per account
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Uncompensated Care
Q: Do you have any national data on uncompensated care as a % of gross revenue?
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Vendor Online Bill Pay
Q: I am interested in hearing from hospitals that use a vendor for on-line bill pay through the hospital’s web site. We want our patients to have the ability to pay by check or credit care without having to validate against a file. In other words, we want patients to have the ability to pay on-line and add their account # and banking information without looking up or validating against an account number. It would be a plus if the vendor also supports checks by phone and the ability to donate to our Foundation.
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Registration Statistics
Q: What is average number of registrations per staff in 8 hour work day? Also, looking for any articles that state the standard or national average for the amount of registrations expected per staff in an 8 hour work day. The information is needed to justify additional staff at the point of service.
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Helipad Charges
Q: We have had a few incidents where the county run ambulance service has met CareFlight at our helipad. The patient never enters our ER, but the ambulance has been in communication with our ER physician. With an order from our ER physician, we have given blood to the ambulance or CareFlight. Of course, the business office has now found out by chance. The lab assumed we billed the patient, but I can’t even find where an account was set up. In my mind, we should bill the ambulance or CareFlight. They would in turn include it on their billing to insurance/Medicare/Medicaid. Thoughts?
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Unemployment and Bad Debt Correlation
Q: I would like to know if HFMA (or any other entity) has any benchmarking data that shows how an increase in unemployment impacts hospital bad debts?
For example, if unemployment increases 1% what has the hospital industry (hospital, market, chain, etc.) experienced in terms of bad debt increases (e.g. % increase)?
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Lost Patient Information
Q: What tactic can our facility impose when a claim is pending for COB information or accident information from the patient, yet the patient cannot be found? Our facility is working on obtaining better information upfront regarding patient demographics; however, bad debt accounts falling into this category are still outstanding.
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Service Fee for Extended Payment Plans
Q: Have any providers put into place a practice of charging a service fee for extended payment plans? If so, what was the outcome/impact? Did it drive more patients to pay at time of service or initial billing period? We are considering a payment options to include 1. a discount for patients paying up front or at time of service or 2. a service fee for patients choosing to extend payment plans over time. Thoughts on the combined approach?
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Small Balance Adjustment
Q: Is there any consensus on best practice for determining small balance adjustment levels for hospitals? For physicians?
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Budgeting for RAC Audits
Q: We are preparing our budgets for the upcoming year and we wanted to know if other hospitals were budgeting for the RACs. Plus, if you are budgeting for the RACs how did you arrive at your budgeted amounts? P>
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Best RAC Claim Tracking Software
Q: What vendor has the best RAC claim tracking software? What vendors and webs cites should we review?
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