Patient billing has become one of the most difficult and complicated processes in the operation of the hospital. It seems like changes are occurring almost daily. It is extremely difficult to stay 'ahead of the curve' on issues that effect the very lifeblood of the hospital. One of these issues is the group appeal that we have initiated regarding Outliers. This issue alone is and will be a major focus of our attention over the next few months. Other specialized billing issues such as proper treatment of blood deductibles and other items have generated additional reimbursement for our clients, as well. Blood has been a very confusing and frustrating issue for patient accounting professionals since 1966 and it hasn't changed much in the interim. In addition, there are other issues that arise as your patient mix changes between traditional carriers and managed care providers.

Benchmark : If you have blood deductibles on your Medicare or other payor bills, if you experienced a growth in Medicare managed care activity, if you have swings in your outlier totals, or any other unusual variances in your revenue/receivable management process, you may need this area reviewed.