Do you remember the television show The Six Million Dollar Man? Steve Austin was an astronaut who had been injured in a terrible accident. At the start of the show, they would always say: "We can rebuild him, we have the technology ... better, faster, stronger." He would become the perfect combination of man and machine.

Don't we all wish we had the six million dollar billing manager working at our provider office? I can see the operation now. We could throw in a computer, a calculator, and the ability to read and comprehend millions of insurance updates. We would sew on four additional arms so he could multitask. And don't forget the most important part, the ability to prognosticate, since predicting the future is a necessary component in billing management.

The bad news is we can't build this person. The good news is we don't have to. Using the right mixture of talent and technology can provide you with a whole team of "six million dollar billers" and give you more clean claims and better cash flow.

Every provider knows that a clean claim will get paid faster and bring money in the door. So, the question is: How do I produce a clean claim and how can technology assist me?

There are many great software and service programs that can help you produce a clean claim. The key is not just having the functionality, but using it appropriately. This means providing training for your team on what is available, and how to use it to improve the performance of claims processing responsibilities. Everyone loves to get new tools that will help smooth daily routines, but without background knowledge, those tools become merely expensive toys.

Five key components for faster claims turnaround are: 1) intake; 2) holding revenue; 3) billing and front end edit reports; 4) auto posting; and 5) denial management.

Intake is the key to the start of the clean claim. If you get the correct information in the beginning, the claim can slide easily through to the next claim processing level. Incorrect or incomplete information can slow down or hold up payment. Focus on admission paperwork completion, claim coverage criteria, and patient eligibility.

There are various programs to assist you in making electronic intake a reality. The reason they are so powerful and helpful is that they control the information going into the system and will not allow you to submit the information incompletely or incorrectly. Controlling field inputs and other mandatory features will save human resource time and unnecessary billing errors. RIT Technology of Buffalo, NY, has designed a Web product that can assist you in the input of information, and MedFORCE Technologies can help as a forms designer. Both have the capability to control the information being collected at the intake process.

Provide reference materials to assist your intake personnel with verifying coverage criteria for the various payors—as well as prior authorization information on claims. This can be done by setting up desktop shortcuts to the various payor Web sites and product information. Consider this instead of printing out the information and placing it in a reference manual.

Verify that the patient qualifies for the products provided (or is given a prior authorization number) to decrease the chance of denial. I have also been to a few provider offices that have designed a company "intranet" site where the intake specialist keys in a product code or description and a list of coverage criteria by insurance is displayed. One company representative is responsible for being current on the criteria, and the intranet site is updated accordingly.

Questions of Eligibility

Sara Hanna

Advancements in technology have provided patient eligibility verification for not only Medicare, but also many commercial payors. Various software vendors provide Medicare eligibility functionality as part of their service. Check with your vendor and train your intake team on how to use it prior to completing the admission of a patient into service.

Patient eligibility allows you to verify if the patient is currently on a home health stay or in a skilled nursing facility as well. One area to be aware of—this information is only as good as the last update. It is not real-time information, so there can be some discrepancy between what is shown and what the patient's current status is. Always question the patient, caregiver, and referral source in addition to checking online to cover all your bases.

HOLDING REVENUE

Life would be so much simpler if we could just get rid of the lag time between providing the service and billing the claim. Holding revenue is an area that leads to many providers' cash flow woes. There are technology providers in our industry that can assist in countering the plight of the held claim. Companies such as Referral Care Network and AuthentiDate assist providers with retrieving medical documentation electronically and via fax that is required for billing. These companies reduce the holding time of your claims and will move them into the billing cycle more quickly than pushing paper out the door and tracking the documents manually. Documents can be digitally signed and all documents transferred without the use of paper.

A new world has opened up for providers through electronic claims submission. By sending claims electronically, providers are realizing quicker turnaround on payments. Again, training and understanding all the features of electronic submission must be addressed and used to see the full benefits of implementation.

Once the claims have been batched together and sent electronically, billers need to understand the returned reports that show the status of the submission. There are two reports that are returned after the submission. These reports are given different names depending on the payor. The first report tells the biller if the whole batch was accepted or rejected. This report is usually received within 2 to 3 hours of batch submission. Billers must review this report to ensure that the batch was received.

The next report indicates which specific claims were accepted/rejected by Medicare's/ payor's system. This report is usually received within 24 hours of submission. Once it is received, the biller should quickly fix the errors that caused the claims to reject and resend to the payor.

AUTOMATIC POSTING

With the increase and availability of 835s or electronic remittance advice, automatically applying the payment to the appropriate claim line is becoming a necessity. How current is your cash posting? The time between receiving the EOMB and posting increases the processing time for the secondary, tertiary, and/or private pay claim. This can additionally cause you timely filing issues with some secondary payors that have short filing periods—especially if your primary claim was denied or delayed for some reason. The solution involves getting as many of your claims back in electronic or 835 formats, and having your billing solution be able to auto post those claims.

DENIAL MANAGEMENT

To find more articles, visit the free archives section at www.hmetoday.com/archives.asp. In the archives, you’ll find a knowledge database including articles such as: September 2007 Is There Life After Losing? By Jeffrey S. Baird, JD

Through the magic of the 835 and advances in functionality by software vendors and other service providers such as RemitDATA, tracking your denials and DSO is now as easy as clicking your mouse. Information derived from the 835 regarding your claims can be aggregated in reports that allow you to evaluate the success of achieving the clean claim. By reviewing these reports, you will be able to see where your denials fall and how to improve the processes within your company to decrease those errors and prevent future claim denials

Technology has the power to speed up claims, but only in combination with a firm understanding and appreciation of billing criteria. Concentrating on just one part of your process will get you limited results. Instead, you must work on all aspects of the process to achieve better results. The "six million dollar biller" is not a dream. You can build it, you have the technology. You can be better, stronger, and faster.

Sarah Hanna is a reimbursement consultant and vice president of ECS Billing & Consulting Inc, Tiffin, Ohio. She can be reached via e-mail: .