Using KIP to bill for DME Claims

You can send Medicare DMERC claims via iPlexus and Zirmed. KIP may be compatible with other electronic claims clearinghouses as well.

First, you need to set up a new Billing Provider just for DMERC (such as "Johnson Podiatry (DME)") and then click the DME tab and choose DME and Medicare.

Then, set up a new insurance carrier such as "DMERC A" - setting the insurance class as "04" and the Electronic Claim Payor ID as "1295" (for DMERC A. Look up the correct payer ID for the DMERC carrier in your area).

Then make sure you enter DMERC A as one of the insurance carriers for each patient (This works best when set as INS 3 since most patients have Medicare primary and a Medicare supplemental plan as secondary).

Remember to use the billing provider "Johnson Podiatry (DME)" and the correct insurance carrier (INS3) on the invoice. DO NOT enter anything on the invoice's DME tab.

Then, when you go to send the claims electronically, remember you have to select "Johnson Podiatry (DME)" as the billing provider - then send the claims as any other claim.

A/R Reports - A Closer Look

Accounts Receivables can make or break your practice. Keeping them under control is a must. That's where the Accounts Receivables Reports come in. They give you insight into where your money is and how long it is taking you to receive it.

There are three main types of A/R Reports:

1) Insurance Summary
2) Sort by Insurance
3) Sort A-Z

Let's take a closer look at these and how they can help keep your receivables low.

Insurance Summary report

The Insurance Summary report is a snapshot of where all your money is. It shows you how much is owed to you by each insurance plan sorted by 30, 60, and 90 days. If you are looking down the Insurance Summary report and notice that Blue Cross owes you $95,000 for more than 90 days and all your other insurance companies owe you $3000 or less, this is a signal for you to find out why. You need to start following up on all these Blue Cross claims ASAP.

Sort by Insurance report

The Sort by Insurance report is more detailed than the Insurance Summary Report. It lists each insurance carrier, with contact information, followed by a list of all patients and their open invoices.

(Beginning with KIP version 10.3.61, the open invoices only include invoices to that insurance carrier - otherwise, they were marked as billed to Ins1, Ins2, Ins3, or Ins4).

This list contains everything you need to call an insurance carrier and request payment information. There is no need to refer back to the computer for claim numbers or policy numbers.

Use this list to call insurance carriers.

Receivables Report Sort A-Z

This is an alphabetical list of all your patients and their balances, both insurance balances and patient balances (also broken down into 30, 60, 90 days). Use this report to get a quick glance as to which patients accounts are past due and require the most attention.

It's like getting a big bonus check

Spending time reducing the amount of money owed to you is like getting a big bonus check. If you can reduce your receivables from $200,000 to $150,000 in one month, it's like getting paid an extra $50,000 bonus check this month.

Don't just rely on your staff to keep up with it. Practice owners should print the Insurance Summary report and keep tabs on their receivables. When you see a large number for one or two insurance carriers looming in the 90 day column, ask why. Print up a Sort by Insurance report for those carriers and see which patient's money is tied up and make sure you find out why. Next month, check it again. If those patients are still looming in that report, find out what's going on.

Remember, after a certain period of time, that money is lost forever.

You will be surprised what you might find. You could find surgeries or procedures that somehow never got billed. Many insurance carriers refuse to pay if you don't submit a claim within 90 days of the procedure. If that money is lost, you are just be working for free.

Make sure your staff is keeping your receivables low and that they know you are keeping track of things. It might be the most profitable thing you do.