Achieving Success with Billing and Collections

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  • 1. Achieving Success with Billing and CollectionsPresented By:John R. Mazza, President/CEO Financial HealthCare Management, Inc. 1400 Johnson Avenue, Suite 4-SBridgeport, WV 26330 PH: 304-842-0307 Fax: 304-842-0315 Web: Email:

2. BE PROACTIVEBeing Proactive Means: Practices ensure that patient demographic andinsurance information is correct, so claims can be filedright the first time. Practices collect from patients at the time of servicewhenever appropriate, to prevent financial losses aftercare is provided. Staff has the information needed to facilitate patienteducation and fulfillment of insurance plan-mandatedrules and paperwork. 3. Electronic Resources for Confirming PatientEligibility and Benefits Use online tools to check patient insuranceeligibility and benefits, co-pay amounts, referralrequirements and claim status. Armed with this information, your team will beable to file the claim correct the first time. Local Carriers currently offering this service:(The Health Plan, Workers Compensation,Acordia, Tricare) 4. Time of Service Collections Consistent co-pay collection is a basicstep that can have a big financial impact. Creates immediate cash flow andeliminates the cost of collecting from thepatient in the future. ACCEPT CREDIT AND DEBIT CARDS!! 5. Enforce Audit Controls Simply translated, an audit control is a processused to ensure that all of the servicesperformed, and all of the payments collected inthe practice, are properly recorded in thepractices computer system and balanced to thebank account. A lack of audit controls is acommon finding in practices that haveexperienced internal theft or embezzlement. 6. 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 thepatient. Services and payments recorded on the encounter forms aretallied manually prior to data entry, so they compared with theinformation system totals after data entry. Manual or electronic encounter forms are reconciled to the daysappointment schedule to ensure that all services scheduled andperformed are turned in for billing. Payments received in the mail are tallied by an individual otherthan the specialist who enters them into the information system.Any variation between the two values must be reconciled. 7. Lockbox Solutions A lockbox is a fee-based service offered bymany banks, whereby payments mailed to thepractice are directed to a bank-managed postoffice box. Upon receipt at the bank, paymentsare deposited, photocopies of the checks areattached to the original EOB remittances, theEOBs are tallied in batches, and the batches areforwarded to the practice. Upon receipt in thepractice, payments are posted as usual. 8. Track Missing Charges Whether managed through a printedreport or viewed from the computer, themissing encounter list must be monitoreddaily to highlight scheduled encountersthat did not have a corresponding serviceposted. 9. File Claims Fast Once a service has been provided, every daythat a claim remains unbilled is one less day thatyou have access to the revenue for that service. Payers continue to impose filing deadlines of aslittle as 30 days from the date of service. Failing to file a claim within the designatedperiod can result in a claim denial, and thepractice cannot collect from the patient. 10. Develop Efficient Charge Capture Tools Physicians in all specialties are usingpersonal digital assistants (PDAs) withcharge-capture programs to streamlinehospital, surgical and office billing. In less technologically advancedpractices, simply developing a hospital orsurgical encounter form will assist thebilling staff in getting claims billedpromptly. 11. File Electronically When You Can, and Work the Electronic Edits Despite the prevalence and acceptance ofelectronic claims, we continue to see practicesrelying on paper claims. MAKE THE CHANGE ! For practices currently submitting electronically,your staff should be working the electronic editreport daily. This report highlights claims thatcontained errors and were rejected by theelectronic claims vendor. 12. Reinforce Timely Filing Deadlines and Track Adjustments Retrospectively Do not let your practice be subject tolosses that can be prevented withphysician and staff education. Post lists of payer filing deadlines. Track and monitor the dollar amount ofany claims denied for reason of TimelyFiling each month. 13. Use Electronic Remittance Electronic remittance is a processwhereby payments and adjustments areconveyed back to the practicesinformation system electronically from thepayer, eliminating the need for manualdata entry. 14. Process Patient StatementsBi-Monthly Processing patient statements in bi-monthly batches, instead of one largebatch each month helps the practice toeven out the patient question calls thatresult on receipt of their bills. Cash flow can also improve and becomemore predictable and consistent. 15. Review and Correct EOB Denials Promptly The first step in managing patientaccounts is to review and resolve theclaims that are highlighted in EOBremittances returned unpaid by theinsurance carriers. Dont spend hours on the phoneresearching the reason for denial. Theanswer is usually on the remittance. 16. Follow up on Accounts by Age and Dollar Value Get the best and most return for youreffort. Work accounts by highest dollar claims. Work accounts by time sensitive payertypes. Inquire about multiple claims on the samephone call or check claim statuselectronically on multiple accounts fromthe payers web site. 17. Dont Forget to Work Credit BalancesCredit balances are a two-prongedproblem for practices. First, they understate the value of theaccounts receivable by offsettingunresolved accounts. Second, they represent a liability to thepractice; if claims are paid twice byinsurance carriers or patients, that willmoney will need to be refunded. 18. Train and Educate Coding and modifiers. Are claimsbeing denied as bundled, lacking medicalnecessity or lacking supportingdocumentation? Do EOBs show lineitems with zero payment? Have thoseresponsible for coding ever attended aformal coding workshop focused on yourspecialty? Do physicians understandevaluation and management criteria? 19. Train and Educate Reimbursement guidelines. Doesstaff have access to tools that outlinepayer reimbursement guidelines (e.g.Medicares Correct Coding Initiative,Medicare Part B News and other carrierbulletins) to effectively direct their appealefforts? 20. Train and Educate Information system. Has staff receivedupdated training from the informationsystem vendor on system features andreports? Does staff respond, We cantget that from the system, when yourequest data related to billing andcollections? Does staff have access toautomated coding programs that eliminatethe need for multiple manuals? 21. Train and Educate Internet. Does staff have access toInternet-based resources that will supporttheir efforts to be proactive and efficient?Is the team trained to navigate the Web toaccess Medicare and other payerguidelines? 22. Monitor Results Key IndicatorsGross 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. 23. Monitor Results Key Indicators Net Collection Percentage. Measuressuccess 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 24. Monitor Results Key Indicators Days in Receivables. Measures howlong, on average, it takes to get a claimpaid.Total Accounts Receivable Average Daily Charges**Total Charges/365Target Level: 30 45 Days. (Based uponpayer mix and mandated claim deadlines) 25. Monitor Results Key Indicators Percentage of A/R over 90 Days.Shows relative age of accountsreceivable; as accounts age they becomemore difficult to collect.Accounts Receivable Over 90 Days OldTotal Accounts ReceivableTarget Level: 20 25 percent or less 26. Conclusion Set clear goals and expectations to yourstaff. Provide necessary training when errorsare identified. REWARD exceptional and consistentlygood staff efforts. GOOD LUCK AND THANK YOU