Careful billing improves reimbursement rates
Your efforts to bill for occupational health case management will have to be carefully constructed to avoid some of the assumptions that you are just seeking additional revenue for routine services, cautions Mike Grosh, president of SPAN Corp., an occupational health consulting firm in Ann Arbor, MI. To improve your chances of reimbursement for case management services, Grosh makes these recommendations:
• Don’t try to bill for anything that your clients expect as "routine" for occupational health.
Restrict your case management billing to services that truly go above and beyond the typical communication and patient care that you provide to all patients. Not only are you more much more likely to receive reimbursement, but you are much less likely to upset your clients.
Aggressive billing can backfire
"This can backfire on you if you get so aggressive you start sending out case management bills for all those things that you promised your clients when you were trying to sign them up," Grosh says. "Clients would leave you in droves if they got a lot of extraneous bills for things like that."
• Establish a legitimate case management service within your program.
This might be the bad news: If you want to bill for case management, you have to have a real case management program. That means having staff who can provide case management beyond what your clinical staff does on a regular basis. And be sure your program involves a credentialing process.
"Physicians’ nurses aren’t necessarily case managers," Grosh says. "If you can point to credential case managers providing a service, that looks a lot better than saying your doctor does it somewhere along the way."
• Use a referral process, just as you would for any other health care service.
Insurers and employers often will balk at what appears to be a self-referral designed to increase revenue. To avoid that impression, Grosh recommends first securing the authority of the employer to refer the patient to case management. If the employer is reluctant, you should make it clear that you are willing to refer the patient — happily, and with a smile on your face — to an outside case management provider. Doing so will assure the employer that the case management service truly is needed, and in most cases, the employer will agree to use your own in-house case management. Securing the employer’s approval upfront also should improve your chance of reimbursement from the insurer.
"Case management is a valid service, and if you’re really providing it, you absolutely should be paid for it," Grosh says. "It just has to be handled with a great deal of sensitivity."
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