It seems pretty obvious: You do the work, you get paid. But unfortunately for many in the healthcare business, it’s not always that black and white.
There are so many obstacles to proper payment, including: complex and confusing billing systems; patients unable to pay their office copay, co-insurance, or deductibles; high outstanding accounts receivable; improper coding vs. documentation; etc. All this and more can lead to outstanding bills and ultimately low cash flow for the practice.
Here are some tips to make sure your practice gets the compensation it deserves:
The Right Code: ICD-10
With the new ICD-10 rules taking effect Oct. 1, it’s imperative that your practice management software and EHR are up to date and that the billers in your practice are trained and ready to go. Improper documentation at some point in the chain of work can lead to a deficit in your bottom line. Make sure that your software is ICD-10-ready.
Ignorance Is Not Bliss: Pay Attention to the Details
Doctors, office managers, and certain staff should be able to access at-a-glance details and have the ability to generate reports if they are employing an efficient billing system. Every doctor should be able to easily access the following data:
• Average daily and monthly revenue categorized by HCPCs and insurance
• Number of outstanding accounts receivable
• Cash value of outstanding accounts receivable
• Number of audits paid/failed status
• Payment and claim status
• Outstanding revenue by HCPCs and insurance
• Monthly adjustment reports
If you are a doctor in a private practice and can’t access this critical information, then at a minimum, you should require a weekly billing report from billing staff or your outsourced billing service. This weekly report should cover the items listed above and will allow you great insight into the "health" of your practice.
Verify Patients’ Benefits Before Their Visit
At the very least, verify patient's benefits before they leave your office. It sounds fairly obvious, but many practices don’t get the patients’ copay before they see the doctor. This could be rectified as easily as keeping patients’ credit cards on file, so it can be the default if the patient fails to bring cash to their visit. Better yet, utilize a practice management system that seamlessly updates you with this information so that you can easily charge in the office. You’d be surprised how something so simple can increase practice cash flow.
Claim Denied? Don’t Let It Go
Make sure your billing staff is diligent about following up on denied claims. Making sure your billing staff or billing service has the right codes can significantly improve this denial rate, but when it does happen, don’t let it go. There should always be follow up on denied claims, but ideally, your billing staff or service should try to catch coding errors before they’re made. Catching coding errors is often better handled by a sophisticated, outsourced billing service — just make sure it offers a transparent view into billing success.
Michelle Tohill is director of revenue cycle management of Bonafide Management Systems and oversees all billing programs and processes. Her specialty is conducting accounts receivable (A/R) audits to expose inefficient billing practices that fail to fully reimburse physicians for their work. She conducts A/R audits and provides Bonafide customers with training and consulting on how to improve every aspect of billing and practice management to maximize revenue. She can be contacted at [email protected].