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

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?

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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?

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Appointment staff
Front office staff
Clinical staff
Medical providers
 Work up a detailed process flow-chart for each
staffing group
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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 60-150 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%)
50,000
45,000
40,000
35,000
30,000
25,000
Billed
Paid
20,000
15,000
10,000
5,000
0
Sept
Oct
Nov
Dec
Jan
Feb
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 - [email protected]
 Rochelle Green - [email protected]
 www.NIATx.net
 Link to NIATx Billing Guide -
http://www.niatx.net/Action/PromisingPractices.aspx
 Link to ACTION Campaign II Webinar Library –
http://www.niatx.net/Action/WebinarLibrary.aspx
 Link to NIATx Blog http://www.niatx.net/Mediacenter/Blog.aspx?SPNID=34