Front Desk
Getting a claim paid really starts at the front desk. Make sure you get good information. Get copies of insurance cards, driver’s license or ID. Have your staff verify the patient filled out your patient registration form completely. Verify insurance and coverage.
I strongly suggest that the front desk NOT enter the demographic information into the computer system. Why? Distractions abound. They are so busy answering phones, checking-in /checking-out patients, and helping patients and physicians, that mistakes can easily happen. Just have them enter enough demographic info to make an appointment. Accurate information from the onset makes the claim process go smoothly and quickly.
Additionally, have a good financial agreement for the patient to sign. Most agreements I have seen are only a couple of sentences and are quite inadequate. Include in your agreement collection fees, interest, attorney and court cost. This way if you have to go after the patient for payment they are responsible for the additional costs of collecting what they owe. You may also want to include that they agree to pay for afterhours telephone advice, no-show fees, form fees, prescription refills, walk-in fees, returned check fees and a billing fee if a patient does not pay their copay at time of service. A good financial agreement gives you the tools you need to collect patient balances.
Charge Posting of Encounter Forms
Along with your front desk not entering demographics and insurance info, they should also not post charges for the same reason, distractions. Charge entry should be done in a quiet location. A claim with the smallest amount of inaccurate data will hold up your payment. Also your nurses or medical assistants provide logs of labwork, sonograms, EKGs or other procedures so that your poster can cross reference the logs to the fee tickets to insure nothing is missed.
Insurance Claim Submission
A clearinghouse is where your electronic claims are sent for processing. These companies that acceptinsurance claim submission include names such as Emdeon, PayerPath, and RealMed. Not all clearing houses are created the same. I found that RealMed stands far above the crowd. Why? Because we have found we can do much of our follow-up immediately with their system.
With other clearinghouses usually the claims go through some type of cursory filtering software to make sure they are accurate and all information is there. Within 24 hours a paper report is sent back with errors it catches for you to fix and resubmit. Hopefully you will be able to get to those reports in a timely manner.
With RealMed everything is done online over the internet. As soon as claims are uploaded into RealMed’s system, their claims editing software catches any errors and kicks the claim right back to you into an electronic cue. At this point the error on the insurance claim is highlighted and a message indicates what you need to do to fix the claim. As soon as you fix the claim on screen you just click and it is off again.
RealMed even goes a step further, communicating directly with the insurance companies in real time. So let’s say something gets past its claim edit filter, it then cross references the claim to the insurance company data base at Aetna, CareFirst, MAMSI, Cigna and the like to check for eligibility, dates of birth, relationships and correct ID numbers. If something is incorrect, it flags it again and sends it to your cue. If it is an eligibility issue you just click a button to see if the policy information matches the insurance records. If it needs changing, the program will change it for you and forward the claim.
With some of the other clearing houses this step would only be accomplished when you receive the EOB back in the mail after 30 days and it is denied. At that point you will have to research the problem and resubmit the claim. All taking additional time that could be spent fighting for your money on other claims.
Insurance Follow-up
Physician offices are busy places. Your billing people are sometimes pulled to cover the front desk or other pressing duties. What does that mean? They don’t have enough time to do the follow-up that is required to get claims paid. Follow-up is usually what falls by the wayside but is vital to a profitable practice. So make sure you have enough staff.
I know of one practice where the office manager was also the biller and was so overwhelmed that she stuffed checks and EOBs in a file cabinet. When she left the practice the physicians discovered $100,000 in uncashed checks and EOBs in that cabinet. As you know insurance companies count on you not doing claims follow up. As a matter of fact, one insurance company’s motto is “When in doubt, dup it out”. Meaning just call it a duplicate claim and hopefully the doctor’s office will not follow-up on it. If you don’t follow-up, they don’t pay the claim and it is profit to the insurance company.
The number one thing you must do is have your staff follow-up. Run reports on outstanding claims over 120 days and start working them. Now make sure you work on them efficiently. If you just have your staff call on claims they could be on the phone for hours to resolve only a hand full of claims. Make sure that you are signed up with each insurance company’s website. Here you can check claim status and write appeals quickly online. This way they will be able to check on 10 claims in the time it may take to check on one over the phone thus increasing the productivity of your staff and money in your hand.
Scanning Documents
Scanning your Explanation of Benefits EOB is a great idea. There is software you can purchase off the shelf that can suffice for most practices for about $100. The price of scanners has come down dramatically.
How does scanning improve the way you collect money? Well, think about how your staff currently files EOBs. Most offices keep them in boxes piled high. If you are doing insurance follow-up or filing a secondary claim and need access to an EOB you have to take the time to hunt it down, move boxes, and sort through thousands of documents. And if the EOB you need is in storage it could be days or weeks before your staff will retrieve it. If those same EOBs are scanned, a biller can call the document up on their monitor in a few seconds. Thus they are being more productive– spending time getting you money instead of time wasted sorting through papers, moving boxes and getting a backache.
Patient Collections
We could spend a lot time on this patient billing. But in regards to over 120 days, make sure you update your patient financial agreement so if the patient does not pay after you have gone through your in-house collection procedures, you can move the account to a collection agency or attorney.
Your most effective tool, however, is your front desk checkout staff. Make sure they not only collect the copayment at time of service but collect any balances due. Hold your staff accountable by requiring them to note why a balance was not collected when the patient was in your office. Good practice management systems even print the balance due right on the fee ticket. If it does not print, your staff needs to be trained to look if there is a patient balance to collect when the patient is standing in front of them.
Also, automate the patient statement process. There are several companies that will allow you to upload a file with patient info and balances from your computer and will print and mail the patient statements for you– usually for less than you can do it yourself.
Use technology as much as you can to make your staff more productive. Don’t look at it as a cost to you but as an investment. For example, if you spend a thousand dollars or so to make your people more productive, they will have more time to work on the outstanding claims and thus be able to bring in tens of thousands of dollars or more each year with no extra work from the physicians. The money is there, you earned it, now make sure you get it.
Putting the Pieces Together
There is a lot involved in trying to get your claims paid and getting them paid as quickly as possible. The claims process starts at the front desk and continues to the final resolution of the claim. Each piece along the way helps to insure timely collection of your money. We have just touched on the basics. There is much more you can and should do but if you start with these basic pieces you should see an improvement in your over 120 day accounts receivable in a relatively short time.
