Achieving Success with Billing and Collections Presented By: John R. Mazza, President/CEO Financial HealthCare Management, Inc. 1400 Johnson Avenue, Suite 4-S Bridgeport, WV 26330 PH: 304-842-0307 Fax: 304-842-0315 Web: www.fhcm.net Email: email@example.com
BE PROACTIVEBeing Proactive Means: Practices ensure that patient demographic and insurance information is correct, so claims can be filed right the first time. Practices collect from patients at the time of service whenever appropriate, to prevent financial losses after care is provided. Staff has the information needed to facilitate patient education and fulfillment of insurance plan-mandated rules and paperwork.
Electronic Resources for Confirming Patient Eligibility and Benefits Use online tools to check patient insurance eligibility and benefits, co-pay amounts, referral requirements and claim status. Armed with this information, your team will be able to file the claim correct the first time. Local Carriers currently offering this service: (The Health Plan, Workers Compensation, Acordia, Tricare)
Time of Service Collections Consistent co-pay collection is a basic step that can have a big financial impact. Creates immediate cash flow and eliminates the cost of collecting from the patient in the future. ACCEPT CREDIT AND DEBIT CARDS!!
Enforce Audit Controls Simply translated, an audit control is a process used to ensure that all of the services performed, and all of the payments collected in the practice, are properly recorded in the practice’s computer system and balanced to the bank account. A lack of audit controls is a common finding in practices that have experienced internal theft or embezzlement.
Perform a Daily Close (Key Steps)• Services and payments are recorded on the encounter form, reflecting the value of the service and amounts collected from the patient.• Services and payments recorded on the encounter forms are tallied manually prior to data entry, so they compared with the information system totals after data entry.• Manual or electronic encounter forms are reconciled to the day’s appointment schedule to ensure that all services scheduled and performed are turned in for billing.• Payments received in the mail are tallied by an individual other than the specialist who enters them into the information system. Any variation between the two values must be reconciled.
Lockbox Solutions A lockbox is a fee-based service offered by many banks, whereby payments mailed to the practice are directed to a bank-managed post office box. Upon receipt at the bank, payments are deposited, photocopies of the checks are attached to the original EOB remittances, the EOBs are tallied in batches, and the batches are forwarded to the practice. Upon receipt in the practice, payments are posted as usual.
Track Missing Charges Whether managed through a printed report or viewed from the computer, the missing encounter list must be monitored daily to highlight scheduled encounters that did not have a corresponding service posted.
File Claims Fast Once a service has been provided, every day that a claim remains unbilled is one less day that you have access to the revenue for that service. Payers continue to impose filing deadlines of as little as 30 days from the date of service. Failing to file a claim within the designated period can result in a claim denial, and the practice cannot collect from the patient.
Develop Efficient Charge Capture Tools Physicians in all specialties are using personal digital assistants (PDA’s) with charge-capture programs to streamline hospital, surgical and office billing. In less technologically advanced practices, simply developing a hospital or surgical encounter form will assist the billing staff in getting claims billed promptly.
File Electronically When You Can, and Work the Electronic Edits Despite the prevalence and acceptance of electronic claims, we continue to see practices relying on paper claims. MAKE THE CHANGE ! For practices currently submitting electronically, your staff should be working the electronic edit report daily. This report highlights claims that contained errors and were rejected by the electronic claims vendor.
Reinforce Timely Filing Deadlines and Track Adjustments Retrospectively Do not let your practice be subject to losses that can be prevented with physician and staff education. Post lists of payer filing deadlines. Track and monitor the dollar amount of any claims denied for reason of “Timely Filing” each month.
Use Electronic Remittance Electronic remittance is a process whereby payments and adjustments are conveyed back to the practice’s information system electronically from the payer, eliminating the need for manual data entry.
Process Patient Statements Bi-Monthly Processing patient statements in bi- monthly batches, instead of one large batch each month helps the practice to even out the patient question calls that result on receipt of their bills. Cash flow can also improve and become more predictable and consistent.
Review and Correct EOB Denials Promptly The first step in managing patient accounts is to review and resolve the claims that are highlighted in EOB remittances returned unpaid by the insurance carriers. Don’t spend hours on the phone researching the reason for denial. The answer is usually on the remittance.
Follow up on Accounts by Age and Dollar Value Get the best and most return for your effort. Work accounts by highest dollar claims. Work accounts by time sensitive payer types. Inquire about multiple claims on the same phone call or check claim status electronically on multiple accounts from the payers web site.
Don’t Forget to Work Credit Balances Credit balances are a two-pronged problem for practices.• First, they understate the value of the accounts receivable by offsetting unresolved accounts.• Second, they represent a liability to the practice; if claims are paid twice by insurance carriers or patients, that will money will need to be refunded.
Train and Educate Coding and modifiers. Are claims being denied as bundled, lacking medical necessity or lacking supporting documentation? Do EOB’s show line items with zero payment? Have those responsible for coding ever attended a formal coding workshop focused on your specialty? Do physicians understand evaluation and management criteria?
Train and Educate Reimbursement guidelines. Does staff have access to tools that outline payer reimbursement guidelines (e.g. Medicare’s Correct Coding Initiative, Medicare Part B News and other carrier bulletins) to effectively direct their appeal efforts?
Train and Educate Information system. Has staff received updated training from the information system vendor on system features and reports? Does staff respond, “We can’t get that from the system,” when you request data related to billing and collections? Does staff have access to automated coding programs that eliminate the need for multiple manuals?
Train and Educate Internet. Does staff have access to Internet-based resources that will support their efforts to be proactive and efficient? Is the team trained to navigate the Web to access Medicare and other payer guidelines?
Monitor Results “Key Indicators”Gross collection percentage. Helpful internal measurement of contract profitability; not useful in benchmarking to others.Total Receipts – Refunds Total ChargesTarget Level: Varies based on fee schedule and payer reimbursement levels.
Monitor Results “Key Indicators” Net Collection Percentage. Measures success in collecting collectable dollars. Total Receipts – RefundsTotal Charges - Contractual AdjustmentsNote: Collection Transfers and Bad Debt Write Offs should not be included in Contractual Adjustments total.Target Level: 95 – 100 percent
Monitor Results “Key Indicators” Days in Receivables. Measures how long, on average, it takes to get a claim paid.Total Accounts Receivable Average Daily Charges**Total Charges/365Target Level: 30 – 45 Days. (Based upon payer mix and mandated claim deadlines)
Monitor Results “Key Indicators” Percentage of A/R over 90 Days. Shows relative age of accounts receivable; as accounts age they become more difficult to collect.Accounts Receivable Over 90 Days Old Total Accounts ReceivableTarget Level: 20 – 25 percent or less
Conclusion Set clear goals and expectations to your staff. Provide necessary training when errors are identified. REWARD exceptional and consistently good staff efforts. GOOD LUCK AND THANK YOU