Yearly Checklist

Yearly Checklist for Billing Service Managers

Credentialing

• Request for contract updates (group and individual)
• Update the insurance picklist based on existing/new contracts

Fee Schedule

• Update fee schedule (billable CPT codes, Medicare multiplier, charge amount)
• Update fee schedule based on the contracted rate and link to insurance picklist to run allowable mismatch. This will help you monitor the net collection ratio (NCR.) The net collection ratio is measured by the difference between your charge and the payer’s allowed amount. It’s a key indicator of how much money is truly collectible, minus any contractual discounts that have already been negotiated.

Practice Guidelines

• Review and update practice specific guidelines
• Make sure the client is assigned to an Account Management Team -TBA
• Confirm that acknowledgments are signed - TBA

Yearly Report should include:

RVU

• Create RVU report by CPT and insurance and send to the client

Claims

• Charge Review – ensure that all claims are completely billed.
• Charge Trend per CPT and Payer
• Be aware of the ICD and CPT Coding updates

Revenue

• Revenue trend per CPT and Payer

Rejection and Denial

• Create a Rejection and Denial trend

Example: Eligibility – top carriers

Authorizations – top CPT & carriers

Referrals – top CPT & carriers

Current and Upcoming Policy Changes

• Keep up to date with the current and upcoming policy changes most relevant to the practice