Improve your practice's cash flow by implementing the following 10 tactics to maximize revenue: - Understand the entire revenue cycle
- Obtain accurate patient information
- Inform patients of your financial policies
- Use ABNs and waivers for non-covered services
- Collect co-payments and balances due at time of service
- Ensure that all charges are being captured
- Review EOBs
- Track denials by reason and by payer
- Utilize automatic payment posting when possible
- Update and review fee schedules
1. Understand the entire revenue cycle
| Implementing certain processes along the way can help you successfully collect from patients and health plans. |
Understanding the entire revenue cycle is critical to improving your billing processes so they function more efficiently.
Many medical practices consider claims submission and payment posting as the billing process when in fact, everyone in the office plays an important role in this critical function. Billing functions begin at the time a patient schedules an appointment and end when payment for services is received.
Elements of the billing process include:
- Patient registration
- Charge entry
- Claims submission
- Payment posting
- Accounts receivable follow-up
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2. Obtain accurate patient information | Obtaining accurate information on the front end will result in fewer headaches on the back end. |
It's critical to the billing process that your staff collects and enters accurate demographic and insurance information up front.
For new patients, collect their address, telephone number(s), birth date and insurance information when they schedule their appointments.
For established patients, the receptionist should verify the same information upon arrival for their appointments.
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3. Inform patients of your financial policies Your practice should communicate its financial and billing policies to all patients. A simple, one-page document summarizing your financial policies should be signed and dated by the patient and placed in his or her file.
Your financial policies document should address the practice’s expectations in terms of:
- Time of service payments
- Authorizations
- Insurance and demographic information
- Collection policies
- Cancellation policies
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4. Use ABNs and waivers for non-covered services Medicare requires that patients sign advanced beneficiary notices (ABNs) prior to receiving certain services. Other payers may require patients to sign similar waivers.
These ABNs or waivers ensure that the patient is aware that they are responsible for any non-covered services.
The practice could lose revenue if the patient doesn't sign the waiver form, as Medicare is not obligated to pay for the services.
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5. Collect co-payments and balances due at time of service Collect co-payments and balances due when you have the golden opportunity—when the patient is in the office! This helps to avoid incurring additional time and expense for billing patients later.
Always remind patients of co-pays and outstanding balances when scheduling or confirming appointments.
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6. Ensure that all charges are being captured | A manual of billing policies and procedures can ensure consistency of billing-related tasks and serve as a training tool and backup resource. |
Each day you should reconcile encounter forms with the appointment schedule to ensure that there is a corresponding charge for each patient who received services.
The total charges on the encounter forms should then be reconciled to the daily transaction reports generated from your computer system. Many systems also have the capability of printing reports to track missing encounter forms.
Another area where charges are likely to be missed is hospital and nursing home visits.
Be sure to use a tracking method to capture these charges, such as preprinted index cards or forms that the physicians can carry with them. Often these facilities will provide patient lists for your billing staff to use to verify that all services were provided to the practice.
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7. Review EOBs An explanation of benefits (EOB) provides valuable information that can help improve your practice’s billing and collection processes. Review EOBs on a regular basis. At a minimum, review a sampling of EOBs each month.
Some things to look for are:
- Timeliness of payments from individual payers. This allows you to concentrate on those payers who are typically slow in paying.
- Accuracy of payments by comparing contracted rates to the amount reimbursed.
- Amounts paid in full indicating that practice charges are too low.
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8. Track denials by reason and by payer
Tracking denials will help you determine where problems exist in the billing process, making it possible to address them and potentially reduce denied claims. For example, a pattern of denials related to incorrect insurance information may warrant re-training staff on properly collecting this information up front.
It's also important to track denial reasons by payer. Because each payer may have specific rules (i.e. bundling), it may be necessary for billing staff to determine the correct way to code certain claims to ensure timely and correct payment.
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9. Use automatic payment posting when possible
Use automatic payment posting wherever possible. It's not only efficient; it's typically more accurate than manual posting.
Staff responsible for posting payments will have more time for other responsibilities such as follow-up and collection on outstanding balances.
Medicare and many larger payers offer automatic payment posting.
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10. Update and review fee schedules
| Insist on the full list of contracted fees. If unsuccessful, ask for the top 10 or 20 codes used by your practice. |
Make sure to update your practice’s fee schedule annually or when payer contracts are updated.
Set realistic charges for all codes to ensure that maximum reimbursement is achieved.
Compare charges with Medicare fees and contracted fees from other payers your practice participates with. Insurance companies will pay the lesser of the contracted amount or the billed amount. Billing less than the contracted amount will result in lost revenues for your practice.
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Source: Content of this Web article courtesy of PMSCO Healthcare Consulting, a subsidiary of the Pennsylvania Medical Society, which provides a full range of health care consulting services to physicians, hospitals, third party payers and other health care organizations. For more information, go to
www.consultpmsco.com.