Issue: #35September 2020
In This Issue
Info Needed List
Now More Than Ever
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Dear SMB Client,

 

If there is one lesson to learn in 2020, it is adaptability.  As we are now more than halfway through this unpredictable year, we see each of our podiatrists and their practice continue to adapt and navigate to our constantly changing environment.  SMB knows it must relay on its successful and proven 20 years of honed in podiatry medical billing skills to keep our clients thriving.  In this year filled with unknowns, one certainty is that SMB has and will continue to operate at full status and maximize our client's reimbursements.

 

From all of us at SMB, we hope you have a safe, healthy and calm Fall.  

 

Sincerely, 

SMB 

 

What Is This "Info Needed List" About Anyway?
By: Cheryl Sands
  
Cheryl Sands Executive Vice President
If you have been with us for very long at all, you will have heard of the "Info needed" list. This is something we tackle very diligently.

If a claim lands on this dreaded list, there is a good reason. We do not have one or more of the following:
Patient Demographics - If a patient is new to you, we must have their pertinent information. If they are an existing patient and any of their information has changed, we must be alerted. (Address, new insurance, etc.)

Correct Insurance - If we are asking you for this, it means we tried the insurance we have on file and there is a problem with it. (New id number or insurance terminated, etc.)

Pre-Authorization, Pre-Certification, and Referral - This one is huge. There are certain insurance companies that require you to have a pre-authorization, referral or to pre-certify a procedure, visit, or anything done to their member. Please make a list of these insurance companies and get in the habit of calling them prior to seeing your patient. I would call every time if you do not know. These denials happen daily and then we have to put the claim on hold and ask your office to retroactively get a pre-auth, pre-cert or referral. It is much easier if you obtain this up front. It saves us all a big headache.

DLS and PCP - This is a big culprit on the info needed list. Any Medicare or Medicare Replacement plan requires us to include the date the patient last saw their Primary Care Physician and their PCP full name and NPI number. Get in the habit of asking every patient this question and noting it.

Nursing Home Face Sheets - are some of the worst sets of information we get. It comes to us with old Medicare id numbers, hard to read copies and outdated information. As far as obtaining the new Medicare id number: Some of the time we can cross reference on a website we use and get the new id number, if we have the patient's social security number, correct name and date of birth. We do all we can, but sometimes we are not able to put all the puzzle pieces together and we have to ask for help. Especially if "Bunny" Smith is the name on the face sheet and her legal name is Elizabeth! Yes, we get nicknames all the time. Fun in life, but not so much in the billing game! (Also, 123456789D is not a good indication of the patient's social security number. That is their husband's social security number, we are not able to use that to find their new id number. (The D indicates deceased husband.) We do pick up the phone and call Nursing Homes sometimes. Some are helpful and some are not.

Please help us by keeping up on these "info needed" requests. We want to get these clams off of hold and out the door to get you paid. Thank you for all you do. Most of you are amazing responding to anything we need, and we appreciate that!

Now More Than Ever - Maximize Reimbursements

By: Chad Bixler

Chad
Chad Bixler
Business Development

Now more than ever with the challenges imposed by Covid-19, a practice needs to maximize reimbursements.  SMB Medical Billing (SMB) is known for maximizing reimbursements for their clients. This article examines some of the ways that SMB maximizes reimbursements.

 

First, SMB works to ensure the correctness of your claims. Your Biller, not a machine, personally inspects each and every claim for the compliance to the most current billing rules, procedures, etc. SMB knows the correct diagnoses for each procedure.  Billers have mastered the use of billing modifiers. It is important for initial claim submittal to be correct.

                                                                                                                                             

Next, SMB's Billers knows how to submit the claims to maximize reimbursements. They understand the order in which diagnosis and procedures are listed in a claim affects reimbursement rates. SMB's people have in-depth experience and are very successful preventing bundling. Billers are experts at maximizing reimbursements for surgical procedures. These factors make a big difference for podiatry practices.

 

SMB takes the time and makes the effort of working with the insurance payors, both commercial and Governmental. SMB quickly processes claims received to keep revenue consistently flowing.  Each payor has unique claim requirements and to master these requirements, as SMB's Billers have, significantly increases a claim's payout. Each payor also has unique and complex rules for claim documentation which SMB has mastered.  SMB maintains frequent contact with payor to ensure claims are not "lost". When a discrepancy between the SMB expected claim payout and the amount a payor reimburses falls short, the Biller quickly addresses the issue with the responsible party; payor, clearing house, etc. These tasks take time and effort, however the end result is very lucrative for our clients.

 

SMB have been collecting, updating and refining the organization's knowledge about how to maximize reimbursements for 20 years with over 500 individual podiatrists. All of SMB's employees are US citizens and located in the US which minimizes language and cultural barriers, and possible security risks. 
From all of us at SMB, we hope you have a healthy fall.  Thank you for reading our quarterly newsletter.

Sincerely,
SMB