By Laura Freeman
“What am I doing wrong?”
That’s the question Cheyenne Crowe says she hears most often.
“Usually its either long-time physicians struggling to get reimbursements approved so they can afford to keep their independent practice going, or it’s new doctors about to launch who have just realized that all those years learning how to keep patients healthy haven’t taught them enough about the business side of how to keep a practice healthy,” Crowe, the owner of Billing Consultants of North Alabama, said. “When people are called to be a doctor, they focus on learning to save lives and fight diseases. Navigating multiple layers of business paperwork, numbers and rules requires a different mindset.”
In the United States, medical reimbursement has rapidly evolved so that now most health care is paid either by Medicare, Medicaid or insurers that are rapidly adapting their reimbursement procedures to follow the model established by Medicare and Medicare Advantage plans. In Alabama, this is especially influenced by BlueCross and BlueAdvantage.
“To win the insurance game, you have to learn to play. If you win, you can operate a successful practice. We help providers learn how to play the insurance game and how to be successful doing it,” Crowe said. “Health policy has been changing quickly and that often means changes in reimbursement. You need someone designated to keep up with what is new so changes can be implemented before they affect your revenue stream. It’s also good to review now and then and make sure what you thought was true still stands.
“I had one doctor who wasn’t using the billing code for counseling smokers. I asked him if he asked patients about smoking during their annual wellness visit. He said yes. I asked if he counseled them on the benefits of quitting and how to do it. He said yes. I asked if he was billing it. He said no, and I asked why not. He said “everyone used to say they didn’t pay for that.” I told him to try it next time and gave him the right code to use. He started getting paid.”
Another problem that may be keeping reimbursements from being approved is failing to close the loop. It isn’t enough to refer a patient for a heart echo. When the echo report comes back, you need to review the results and mark it reviewed so you close the loop and your work can be billed.
For primary care providers, the patient’s annual wellness assessment is not only a good way to spot problems early—it can help you make sure you are getting paid for the services you are already providing that may be getting overlooked in billing. You may not have a mental health practice, but if signs of depression warrant trying medication or coordinating care with a mental health provider, it’s a billable service that might just save a patient’s life.
“Some insurance companies are hiring independent contractors to do wellness assessments. The contractors get paid, but that doesn’t affect the provider getting paid. The billing codes are different, and the primary care provider will receive reimbursement for conducting the annual wellness visit,” Crowe said. “Doing the wellness assessment gives you a better overview of your patient’s health and offers prompts to talk about vaccinations, screenings and other services that are helpful and billable. You have a reminder right in front of you so you know if they are getting their mammograms or colonoscopies on time.”
One important tip Crowe offers on the annual wellness check is to be considerate about the patient’s time. “Try whenever possible to schedule it with another visit, either a medication renewal visit or annual checkup,” she said. “Taking off work or finding a ride to the doctor takes effort and people don’t like having to come in just for the annual wellness paperwork. That’s a lot to ask of people with mobility issues and those who don’t have much paid time off. Try to schedule visits so patients can feel like they are getting more done.” That makes patients happier, and happier patients tend to give better quality of care reviews, which can also affect how much a practice gets paid.
Headquartered in Hartselle, Crowe and her staff work with health care providers across the state. With a focus on primary care and mental health clients, the service works with both solo providers and small to medium group practices. In addition to medical billing services, they also advise on billing issues and setting up billing procedures to streamline the process and improve reimbursements. Crowe also often speaks with groups of young doctors about to go out on their own.
“It’s great seeing them getting ready to live their dream,” she said. “For me it’s also satisfying to help them learn how to live that dream and get paid for the good work they do.”