Consider this bromide: “Follow up with the insurer if it doesn’t pay a claim within 30 days.” The trouble with that advice, says Keegan, is that each insurer has its own adjudication cycle for clean claims, and it’s often shorter than 30 days, due to electronic claims submission and payment, not to mention state prompt-pay laws. That means you can get off to an earlier start, chasing down accounts receivable.

“Medicare typically pays clean claims within 14 to 17 days,” says Keegan. “Some private insurers pay in 25 days. You need to determine the cycle for each payer.”

Then, set your follow-up threshold by payer accordingly. If Insurer X doesn’t pay up within the customary 25 days, give it a ring on Day 26.

Another piece of conventional wisdom is “Generate an aged A/R report by payer.” No arguing with that axiom. You need this report to spot slow payers. But don’t stop there, says practice management consultant Judy Capko. In a group practice, age your A/R by provider, as well. Capko recalls how such an analysis tipped off a client of hers to a problem with a new doctor: One insurer wasn’t paying the doctor’s claims because his credentialing paperwork had gotten lost. “There were other ways the group could have discovered this, but the aged A/R report was the key,” says Capko.

The same report can yield positive findings. Maybe one doctor collects 75 percent of his money from Insurer X within 30 days, compared to 50 percent for the rest of the group. “Find out what he’s doing right so that everybody else can imitate him,” says Capko.

Practices with a large billing department often assign billers to particular payers so they can master their claims-processing quirks and get on a first-name basis with payer reps. Such specialization has gotten to be standard operating procedure, but be careful how you divvy up payers lest you create uneven workloads, says Bee.

After all, payers aren’t created equal. Some are more prone to slow-pay and denial-itis than others, which increases your work. Some conduct more of their business electronically, which streamlines it. Worker compensation programs are notorious for making you jump through a gazillion hoops. An out-of-state insurer that’s two time zones away also comes with an increased hassle factor. “You don’t want to overburden one biller with all the hard payers and give another biller the easy ones,” says Bee.

So how do you arrive at the right mix? Consultant Elizabeth Woodcock, a coauthor of “The Physician Billing Process,” suggests giving each payer a “relative difficulty” grade, with traditional Medicare being 1, more difficult payers greater than 1, and less difficult payers less than 1. Then calculate what percentage of claims each payer represents, and weight that percentage based on its difficulty grade. In other words, Payer X generates 10 percent of your claims, but because its difficulty grade is an aggravating 1.6, those claims create 16 percent of the practice’s work. If you have six billers, Payer X would be enough work for one of them. (“The Physician Billing Process” includes a detailed description of how to calculate a difficulty grade.)

Collecting from patients

Under the gun to collect more of their revenue from patients, practices need every tool available — basic and advanced — to streamline what is otherwise a very labor-intensive task.

Liberating patient collections from paper is a good start. At the Web site of 80-doctor Physician Associates in Longwood, Fla., patients make credit card payments of roughly $180,000 a year, says Marko Grguric, the practice’s system analyst. While that’s still only 1.6 percent of total patient collections, it’s more than double what Physician Associates took in online in 2006. This up-and-coming technology for collections is available from connectivity firms Medem and Medfusion. Besides being convenient for patients, online payment speeds up cash flow and reduces the number of bills you have to mail out, saving you time and money.

Online payment technology is evolving, as the Iowa Clinic has learned. For years, its Web site could only accept credit cards. Now the group is switching to an online payment service from Galvanon that also accepts debit cards and electronic checks. That’s an important capability since debit cards and checks come with some health savings accounts. “This will expand the folks who pay online,” says the Iowa Clinic’s Beth McGinnis.

These same features come with Galvanon-brand kiosks found in Iowa Clinic offices. McGinnis credits the plastic-swiping machines with garnering more copays and past-due balances. “One obstetrics-gynecology department used to collect about 40 percent of what was out there in co-pays and balances per month,” says McGinnis. “With the kiosk, it’s up to 60 percent.”

Not every patient is comfortable doing business with a robot cashier, so the Iowa Clinic is also willing to take its money at the front desk instead. Tip: Have more than one credit-card reader if you’re processing a lot of patients at the same time. Bonus tip: Invest in a card reader with a built-in check scanner to convert a paper check into an electronic one, debiting the patient’s account that much faster.

Invariably, you’ll encounter patients bereft of greenbacks, plastic, or checkbook at copay time. Establish a consistent policy on whether you’ll reschedule these patients or let them see the doctor and mail in their money later. If you choose the latter route, make it easy for patients to remember their responsibility by handing them a brightly colored, self-addressed envelope marked “copay” on the inside flap, says Judy Bee. “This is low tech, but it really works.”

Customize, automate, innovate

Not every patient will mail in his copay or past-due balance, nor catch up online. You’ve got to chase them down, but go beyond a one-posse-fits-all approach. Keegan recommends tailoring your follow-up based on the credit status of each patient. “There are three basic categories — insured, employed patients with a record of timely payments; insured, employed patients with a spotty history; and uninsured or underinsured patients,” says Keegan.



The collection cycle for the second group might consist of two letters, a single phone call, and a preliminary letter from a collection agency before the agency takes over completely, she says. “The better paying patients could get an extra phone call, because it’s more likely to be successful. You might want to dispense with follow-up calls altogether for the underinsured or uninsured, but as part of your collection policy, you might help them sign up for Medicaid or charity resources from the get-go.”