Make sure to also run an aged trial balance report by payers. The goal here is to identify problem payers, problem processes, and set priorities for staff.

For example, Roberts noticed that, for one of his payers, the percentage of accounts usually collected within 30 days was suddenly out in the 31-to-60-day bucket. After a little digging, it turned out that the payer was having trouble clarifying what it needed in terms of national provider identifiers and provider numbers. Robert’s practice got a straight answer from the payer, resubmitted the claims, and got paid. That’s taking a proactive stand instead of just waiting around, and tracking A/R by payers made it possible.

Roberts even runs his report by payer and procedure or revenue line. That helped the practice realize that some payers were denying Botox injections every time, and requesting the office note. So now the staff simply sends the office note with the claim the first time, cutting at least 30 days off the payment cycle.

Roberts also challenges payers who are consistently slow at contract renewal time. “I tell them, ‘if you want to dance with us, it’s going to cost you a little more than it would someone else.’ If they are kicking back my claims or losing claims, it’s costing us money, and it should cost them money.”

Keep an eye, too, on noncontracted payers. “They are slower to pay and require a lot more information than your contracted payers to decide on a claim. Since they are usually charged a much higher rate than contracted payers, a few outstanding noncontracted accounts can translate into a large A/R balance,” Khorsand comments.

If some payers are consistently slower than others, it’s also worthwhile double-checking that your staff is reviewing error reports from all your payers every time. An error report shows claims that didn’t make it through the electronic clearinghouse. Those claims need to be immediately resubmitted. But, says Beaver, “We have multiple practices every year where someone realizes while we are there that nobody understands how to pull all the error reports. So they just sit in cyberspace. They end up in an aging report, and you suddenly realize that a payer never got a bunch of claims on one day.”

Take a hard look at your other billing processes, too. “People are perpetually surprised how much they control on the front end,” says Beaver. “They are slack on the front end and pay for it with a big A/R. It’s difficult, but it can be done.”

One of her clients, in addition to using an EMR and claim-scrubbing software, also does a manual review of each claim. Each afternoon, the physician, biller, and receptionist who review the claims catch at least five mistakes daily that wouldn’t be caught by their scrubbing software, Beaver reports. By sending squeaky-clean claims, they slashed their A/R.

Study by patient

Of course, payers aren’t the only issue in these days of huge copays, deductibles, and health savings accounts. Run your report by patient. Then start working down the large balances. If many of your patient accounts are old, you need to start collecting faster.

First, make sure your staff understand that patient collections are a priority. “I have had three practices this year — and it’s only June — where the staff just decided it was too much work to send out patient statements. They were too far behind,” Zupko says. Get those statements out.

But not too many statements. Zupko & Associates advises sending one statement right away, then a second one in your next billing cycle. After that, just send a letter saying the patient has 10 days to pay or the debt will be sent to collections.

Roberts’ office sends “three statements and then we fish or cut bait with collections. I would be draconian and cut that down. Every statement costs money.”

It’s well worth it, too, to train staff to collect at the time of service — the fastest way to get paid. Staff need to be armed with the information and skill set to get the job done, though.

The right touch can make a world of difference. Here’s one easy technique Roberts has observed at a gastroenterology practice: “They gave the secretary a roll of stamps to keep in her pocketbook. If a patient came in without a check, the receptionist reached into her own purse, put a stamp on an envelope, and said, ‘I’d really appreciate it if you’d send this to me this afternoon.’” Patients feel like they owe follow-through to an individual, not just some business.