In the days before managed care, billing was a snap. It seemed you could simply look sidewise at a third-party payer and get paid.

Today, as legalistic coding rules have taken root and payers have gotten stingier, collecting what you’re owed requires fighting a battle on two fronts: the draconian payers on one front — and patients on the other.

You need the latest tools and tactics just to avoid losing ground in this struggle. You can’t afford to keep doing things “the old way.” Accordingly, we’ve asked a coterie of practice-management consultants and administrators for advanced tips on getting what you’ve earned

Notebooks out, pencils sharpened. Class is in session.

Computerize your previsit homework

You’ve heard this advice before:

To ensure a clean claim, collect the patient’s demographic and insurance information before the visit. Practices have traditionally done that over the phone or by mailing patients the usual registration forms for them to complete and return. To take this advice up one notch, post those forms on your practice Web site, assuming you have one (and you should). Patients can print out and complete the forms and then mail or fax them in advance of their visit.

Better yet, enable your Web site to allow patients to complete the forms and transmit them to you electronically (using encryption). Or use waiting-room kiosks to capture the information, rather than handing patients a stack of forms and a pen. Handwritten forms are sometimes illegible, causing staffers to enter inaccurate data that leads to claim denials. At four-physician Northern Virginia Family Practice Associates in Alexandria, almost 100 percent of new patients register online. “Our errors have gone down and our revenue has gone up” since the practice made the switch, says administrator Mary Dooher.

Employees type in the online data just as they would working with a hard copy. What’s more efficient is a Web site that sends registration information straight into your practice management system without rekeying (although you should review it beforehand for accuracy). The major physician connectivity companies — Medfusion, Medem, and RelayHealth — offer such software integration.

Another advantage of computerized registration — whether it’s done on a practice Web site or a waiting-room kiosk — is that you can structure the form so the patient can’t proceed unless he fills in all the blanks. “Patients will skip half the questions if you let them,” says Beth McGinnis, the billing and IT manager for the 120-doctor Iowa Clinic in Des Moines, which has installed kiosks in half of its waiting rooms.

And make sure you’re capturing all the information you need, including patients’ cell phone numbers, says practice management consultant Deborah Walker Keegan. After all, almost 70 percents of adults polled online recently by Harris Interactive reported that they have both a cell and a land line. (Some have only cell phones.) “If you can’t reach them about a past-due balance on the land line, try the cell,” says Keegan, coauthor of “The Physician Billing Process.” Also, you can contact patients during their 9-to-5 jobs on their cells instead of waiting to call their landlines at night, although Keegan suggests getting their approval beforehand to ring their cell.

Clean up your hospital act

Experts say that many practices that earn an A for capturing all their charges in the office are D students when it comes to inpatient charges. It’s not surprising. On the run in a hectic environment and deprived of their usual coding tools, doctors fall into bad habits. “They’re notorious for writing hospital charges on napkins and turning them in late,” says practice management consultant Greg Mertz. So if you want to raise the level of your billing and collection game, get your hospital act together.

Part of the solution is a rounds list — which your hospital may be able to generate — that shows whom you’ve admitted, says Mertz. This list lets billers know what charges to watch for. They can hound Dr. Jones if a charge ticket on Mrs. Johnson in Room 312 never materializes.

Rounding lists can be downloaded into any number of charge-capture programs — complete with coding tools — that you use on a smart phone or PDA. Some electronic medical record programs have inpatient charge-capture modules as well, giving you mobile access to patient charts. Not ready for the software approach?

An alternative, says Keegan, is pairing a doctor on rounds with a nurse or certified coder — call them “humanware” — who can document services and charges. If you’re losing thousands of billable dollars scrawled on hospital napkins that get thrown away, this extra personnel cost may represent a good investment.

One practice that’s taken charge of inpatient charges is 14-doctor Mid-South Pulmonary Specialists in Memphis, Tenn. It posts a master rounding list for its patients in seven hospitals on a practice intranet. Doctors are responsible for updating the list twice a day, noting all consults, follow-up visits, discharges, transfers, and deaths.