Revenue Cycle Department Updates
The RCD went through a huge transition in January which included merging two billing offices with different workflows, building a new data base for practice management and billing, and credentialing the Grove Hill providers with the payers under a new tax id and name. With all of these changes I know there have been some questions about where we are with outstanding AR, revenue cycle workflows and revenue collection in general. I would like to a few minutes update everyone on where we are in the RCD and where we are making changes to improve the collection of the revenue.
Payer issues:
There have been a number of challenges with the merger and the new credentialing that had to take place. Although we worked hand in hand with many of the carriers providing spreadsheets and lists of providers that needed to be set up, there are still issues with claim denials and authorizations that we are working on with the insurance companies. Below is a brief look at the issues that we are having by carrier:
Medicare – Most of the legacy GH branch providers and some of the legacy CMG providers were not set up correctly in Medicare’s system. This caused a reduction in payments of 5% at the non-par rate. The mistake was corrected in late March in their system and claims since then have been paying correctly. The ones that were incorrectly paid are being worked by the RCD manually on a spreadsheet that includes all of the Medicare charges for January, February and most of March. They have begun to reprocess the claims that we have submitted to date. Most of the secondary claims will cross over from Medicare once the claims have been reprocessed and we will automatically receive those payments. Any that do not cross over will be mailed once we receive the Medicare explanation of benefits.
We are still waiting for the lab, mammography and DME to be credentialed. The lab and mammography should be done within the next week or so and we are just waiting for confirmation. DME applications will be going out no later than next week.
There was a delay in some of the Medicare claims going out due the provider’s ID number linking in Centricity. These have all been fixed and claims have been sent out.
United Healthcare/Oxford – Although United is now giving us the “White Glove Service” (their words, not mine), we still have providers that have not been loaded correctly in their system. This has caused many issues with referrals and authorizations on the United Medicare side and as you would expect, many denials that we are working through. Tracy King and I have been meeting with United on a bi-monthly basis to resolve these issues. There has been a promise to reprocess of the claim denials but not until the providers have all been loaded.
Medicaid – we had some glitches with Medicaid billing due to the linking of the providers to the correct taxonomy groups in the Medicaid system. Sarah went manually back through Centricity and relinked all of the providers correctly and all claims have been submitted.
Aetna – We had authorization and referral problems with Aetna Medicare just as we did with United. All of these issues have been resolved and they are working on reprocessing the denials that were received due to this issue.
Cigna – We have had a couple issues with Cigna. As of January 1st all of our radiology was going to Cigna and not Medsolutions. Unfortunately Cigna did not get that message and most of our radiology claims denied. As of yesterday they have figured out the problem with the contract and they are working to it fix in their system and will reprocess all associated claims.
Working with American Specialty Health for our physical therapy services has also been a challenge. We now have the workflow in place for authorizations but are still working in the RCD to submit the claims. We had some issues submitting electronically and now they are requesting the use of a modifier to pay claims. I discussed this yesterday with Cigna and they will work with us and ASH to have this resolved promptly.
Wellcare – Some of our providers have not been loaded and they are working to add those that are missing.
Anthem – We have a number of issues with Anthem from locations not being linked to denials for the exchange plans. Tracy and I are also meeting with Anthem bi-monthly and working through these issues and escalating where we can.
Connecticare – We still have some issues that carried over from the legacy CMG side that we are working with Connecticare on. Along with this there are some questions we are still waiting for answers on that have to do with physical therapy and lab billing. The issue is where we need to place taxonomy codes in our system so it crosswalks to their system correctly.
Fee Schedule:
When we merged in January we were still working through contracting with most of the payers. Given this I created a fee schedule for Starling based on the highest charge from each group. Since then we have received our contracted rates and I have started working on building a new fee schedule for Starling. Most of the changes in the fee schedule will take place on July 1st 2016 and I will continue to work through the others and hopefully have all fees completed by August. The goal is to keep our fees at 15% above the highest payer so we do not miss any revenue. There is a position that will be posted this year for monitoring the fee schedule against what we are being paid by the insurance carriers. Any discrepancies can be worked immediately with the provider reps at each insurance company for faster resolution. This will also allow us to have a dedicated person to work with the office on reporting and analysis related to reimbursement questions.
AR Work Flow:
As I stated above, we have gone through a great transition in the RCD with the merging of our two billing offices. It has been a challenge working through every ones skill set, building work queues and monitoring staff quality and productivity. We’ve tried a few different things to see what is the best way is to handle the combined work load and assign it to the appropriate staff member. Even with that being said the staff has done an outstanding job with all of these challenges but we are not perfect. We are beginning to restructure the AR team so they can begin to work by specialty. Sarah Holcomb and the managers are in the process of assigning staff to the appropriate teams and I will keep you all updated on the progress. We hope to have this new process completed by the middle of July.
RCD Contacts:
We have had many requests from the office to help with issues and have found ourselves duplicating efforts on many levels because the same request for information was given to multiple staff members or the request was going to the wrong staff member. For this reason I have provided a contact list below for the RCD tailored to what the issue is that you may be having.
- Sarah Holcomb – all requests related to the primary RCD functions: coding/charge entry, AR, payments, scanning and customer service.
- Ekats Dubrovina – questions on denial or adjustment trends, registration, OTC and eligibility questions
- Michele Otero – credentialing
- Tina Robinson – reimbursement, fees, anything else.
You are always free to contact or cc me on any communication. I have also asked the practice managers to contact both me and Tracy King if there are any authorization or referral issues related to the merger.
The RCD is working diligently to improve workflows, train and educate staff, communicate timely with the offices and create efficiencies. Making sure that the office is informed is our top priority. I will continue to update everyone on the status of the payer issues listed above. As always, if there is anything that you need me to assist you with please feel free to contact Tina Robinson directly at
(860) 258-3480 ext 1208 or email trobinson@starlingphysicians.com