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

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.

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.

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

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

Tip #5 What 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

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

Tip #7 Utilize 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

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

Tip #8 Payments may come 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%)

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.

Any Questions? John Greenawalt - Rochelle Green - Link to NIATx Billing Guide Link to ACTION Campaign II Webinar Library – Link to NIATx Blog -