Receiving maximum reimbursement with quick A/R turnaround in any healthcare practice requires careful attention to obtaining, documenting and communicating information. From the time a patient schedules a visit until the charge is closed out, proper management of information to and from your billing representative means the different between fast reimbursement cycles and slow, drawn out A/R. Information about insurance coverage, demographics, diagnosis and status of claims - coming from virtually all areas of your practice - should flow clearly and efficiently to support clean claim submission the first time around. Here are 10 opportunities in the lifecycle of a patient encounter where efficient management of information will improve A/R.
- Initial Patient Contact – Front office staff or the patient scheduler should capture ALL pertinent information when a patient calls to schedule an appointment. Capturing general information like name, phone number and reason for appointment is a good start, but make sure you’re catching payor information as well. Does the patient have insurance? If so, who is the carrier, what’s their plan number? If not insured, are they prepared to pay up front and have they been briefed on your payment terms? Either way, answers to these questions will help in the insurance verification step and/or set proper expectations for payment at the time of service.
- Insurance Verification – Either the scheduler or billing representative should use the information from initial patient contact to confirm with carriers BEFORE the office visit. This opportunity offers the chance to confirm enrollment, coverage levels, co-pays/deductibles, etc. Traditional verification of benefits over the phone is effective but time consuming; remember that you can usually save a lot of time using on-line interfaces offered by many carriers today. If the result is “no coverage” for this visit, or the carrier is unable to verify coverage, a follow up call to the patient should yield updated coverage information or at least guarantee everyone is aware of payment responsibilities.
- Patient Registration – When the patient arrives at the office, the receptionist or a member of the front desk staff should verify ALL registration forms are accurate and complete. If it’s an existing patient, the receptionist should re-confirm that records are up to date. This step is the key to obtaining/confirming the detailed demographic data required for insurance claim submission – if anything is incorrect or missing, reimbursements can be delayed as much as a month or more. It’s also helpful for front desk staff to reiterate co-pay or self pay obligations at this time to confirm the patient is prepared to remit payment once the visit is complete.
- Provide Care & Document Services – While the patient is in the exam room, or immediately following the visit, all diagnosis and care should be clearly documented on encounter forms. Patient forms are then forwarded to the front to cross reference with information gathered during insurance verification in Step 2, and the bill for co-pays and self-pay patients is generated.
- Collect Co-payment – All patients should be required to stop by the cashier or reception desk to remit payment for co-pays, self-pay, etc. BEFORE they leave. If preceding steps are completed properly patients will already be aware of obligations, so there shouldn’t be any surprises. A receipt can also be generated now for the billing representative to document exactly how much was remitted by the patient, should any later balance billing be necessary.
- Claim Generation, Submission, and Carrier Review – Clean claim submission is not just dependent on the information gained in steps 1 through 5, but also on processes that manage data efficiently. A good practice management or medical billing software will address this need, but remember that you usually get what you pay for – it’s usually best to not cut corners. The alternative to spending thousands on software is teaming with a professional medical billing company for, usually, a nominal percentage of receivables. Either way, if information is missing at initial claim submission, denial can add several weeks to the reimbursement process. If all moves smoothly, reimbursements can be forthcoming in as little as 1-2 weeks!
- Insurance Reimbursement Received/Documented – Hopefully, all of the preceding steps have progressed smoothly and a clean claim was submitted. Our next step in managing claim information is proper documentation of reimbursements in the medical billing record. This step can often be simplified through electronic remittance and EOB notifications. If you’re not able to use electronic EOBs, then it becomes critical the billing representative is thorough in manual entry of all EOBs received. Keeping close eye on your EOBs – timing as well as reimbursement rates – can also identify which carriers are paying quicker and which might require a follow up call.
- Patient Invoicing – This step is about communication with patients. Just like carriers, providing patients with thorough information will further help to reduce turnaround time and minimize questions. Be clear and note dates of service, insurance payments, fees collected at time of service, and total amount due. These statements should be sent out as soon as an insurance determination is confirmed. Many statistics have shown the sooner an invoice is sent, the more likely, and faster, it will be paid.
- Enter Patient Payment – Upon receipt of the patient payment, the billing representative should enter payment information into the billing system and prepare to close out the charge. If payment is not received within a reasonable amount of time (i. e. 30 days), the practice should have clear policies in place for next steps. Small balances of say, under $5, might be taken as a write off; for larger balances a second invoice might be sent or the patient may be sent to a collections agency for further action. Regardless of your policies, don’t delay in taking action. A/R suffers most when these balances go unaddressed, carrying forward month after month.
- Close Out Charge – Once final payment has been received, or a determination has been made to write off or send to collections, the billing representative should waste no time in closing out the charge.
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