Sometimes It Has To Start With A Phone Call

In general, I hate talking on the telephone, business or pleasure. However, when it comes to business and getting information you need when it comes to revenue cycle issues, I find that it's best to pick up the phone and call someone who you believe has the answers.

I was doing a consulting assignment in Pennsylvania. I was there as the interim director of patient accounting. They had a lot of problems, which included a relatively new computer system that had been installed badly, understaffing (not enough employees to do the work), and multiple billing issues.

There were two people who oversaw compensation claims. They struggled at it because they never got proper training, so their receivables were drastically high. Something about the numbers caught my eye, so I decided to take a look at the charge master regarding physical therapy charges, since charge master work is my main field of expertise.

What I discovered was that most of the physical therapy charges had been coded with physician revenue codes. Obviously that didn't make sense, so I went to talk to the people who were responsible for the charge master. Unfortunately, it was someone who worked in the accounting department, and he admitted that he didn't have a lot of knowledge regarding charge masters, but these were the codes he was given.

The next thing I did was call the director of physical therapy and set up a meeting with him, since they weren't located in the hospital. During our visit, I asked him who provided the physical therapy and he said the department did, which I knew was how it was supposed to work. I asked him if he knew who gave the accounting department the physician revenue codes, and he said he didn't know because he didn't know what they were.

During our conversation he also mentioned that compensation in that state worked different than other states, in that the copy of the charge master regarding physical therapy and all other therapies had to be sent to the state for their approval. He also stated that there were charges that had been created a year earlier that the state had never paid and he didn't understand why.

My next step was to call the state compensation office and start asking questions. I told them up front that I was consulting at a Pennsylvania hospital and that I was from a different state, then I asked them about their policies. I was told that any time new charges were added to the physical therapy charge master, which included if a facility opened up a new department, that all charges had to be sent to the state on a quarterly basis.

If they had a problem with any of the new charges, they would send a letter back to whoever sent them the charges in the first place. If they didn't have a person's name to send it to then they sent it to administration. This included coding problems, which I expected, because I asked them if it was normal for hospitals to send physician revenue codes to them, knowing what the answer was going to be. I was told it was improper, and that they would deny those claims every time if it had a code denoting that they were part of a hospital, whether or not physical therapy was off site.

After that phone call, I went to talk to the accountant again and asked him if they had sent an updated charge master to the state. The guy in charge of handling the charge master stared at me, and then said he didn't know he was supposed to. He had been overseeing the charge master for six years, which explains why their outstanding compensation balance was so high.

Even though I wasn't there for charge master issues, I knew I had to fix this before working with the people who billed compensation. I coded all the charges with the correct revenue codes, which should have been for the services provided (i.e., PT, OT, Speech, etc), and also verified that the CPT (procedure) codes were proper. Then I printed a copy of the physical therapy charges and mailed them to the state compensation office, along with the letter indicating the name of the person they needed to send replies to.

The timing was critical because the next quarter would have begun in two weeks, but I had the name of the person they needed to go to at the state, and had informed him that the charges would be there within a couple of days. He assured me that they would be able to process everything so that by the beginning of September they would be ready to accept any new charges that they didn't already have from the hospital.

The next step was taking a few days to work with the compensation billing people and show them how they should be checking on outstanding claims. It turns out they had never made any phone calls asking about them, so I gave them the information on who to call and the types of questions they needed to ask. I was lucky that there was another consultant who was there helping out the billing department, so I asked her if she could spend some time sitting with them and overseeing how they called the state, the types of questions they asked, and then verify that they were doing it properly.

Sometimes you'll find that you can't get the answers you need from the people you're already working with, which means you have to go right to the source, no matter what project you're working on. Sometimes, you have to start processes by talking on the phone, a lesson I've learned and used multiple times over the years, even if it's not my cup of tea. If that's what's needed to get things started, go ahead, pick up the phone, and start the conversation.