07/10/2017
Why We Use DaisyBill (and why you STILL need us to do your billing!) PART 2
We previously talked about why our business uses DaisyBill for the billing of your Workers’ Comp claims.
In this blog, we will talk about why DaisyBill alone is not enough. You STILL need a professional, competent billing staff with specific, current expertise in California Workers’ Compensation. Partnering with Westshore Medical Billing can result in the increase of tens of thousands of dollars to your practice. Here are some reasons why:
1) Coding: You need a Billing Team who understands current, correct Workers’ Comp Coding. They must know the extremely complex CMS Coding and guidelines and CCI edits, correct Primary and Secondary Coding and how these rules translate into OMFS coding.
2) Electronic Billing. There are still medical practices who do not submit their billing electronically. Please trust us… if you are billing on any other program besides DaisyBill, a large portion of your billing is still being sent the old-fashioned way: by fax or US Mail, which means a large number of your claims are lost, unprocessed or dead on arrival.
3) Penalties and Interest: Last year alone we collected close to $75,000 in P&I for our providers. If a payment is late or denied in error, we’ll go after P&I for you.
4) QME Coding. Every day we see QME Reports that were mis-coded or undercoded by a provider’s billing staff, resulting in thousands of dollars of loss for the doctor. At our office we review every QME report to determine the correct level of complexity, plus any required modifiers. It takes experience and the desire to get it right.
5) Appeals, SBR/IBRs. When these were implemented in 2013 the whole billing to appeals process was forever changed. You have 90 days to appeal a denied or reduced payment through Second Bill Review. Beyond that, you have another 30 days to file for an Independent Bill Review through Maximus to appeal the SBR decision. We either see incorrect, boiler plate SBRs sent reflexively with NO result, or failure to send an SBR at all. We have not seen an office yet that follows through with a request for an Independent Bill Review. Doctors, you are walking away from money you are entitled to when your staff fails to timely and accurately file SBRs and IBRs. But we have this covered for you. Our Billers always file SBRs, and are willing to take it to the IBR level when appropriate.
6) Audit Complaints. As a part of our work for you, when an insurance company flagrantly denies or underpays your claims, we file an Audit Complaint. Audit Complaints are resulting in action being taken against the carrier.
7) Liens and Petitions. There are VERY limited circumstances where you may now file a lien. But when it’s appropriate, we’ll file a lien for you, and follow through all the way to a WCAB Lien Trial if necessary. When QMEs are not paid, a Petition for Costs (or Non-IBR Petition) is appropriate. We file these for you, and get you paid.
8) Reports, Practice Management Statistics and Support. How many times have we heard “I don’t get reports from my staff. I don’t know what I produced last month, or what was paid. I don’t know which services are paying, and which ones are being denied.”? These critical facts are necessary for you to be able to run your practice and determine treatment plans. Only with valuable practice management reports can you determine how you must change your intake, your RFAs, and your own decision-making when creating a treatment plan. You need reports… we provide them.
