Traditionally, practices have focused on the front desk collecting co-payments and have left co-insurances and deductibles to patient billing after the claim has been processed. This creates a lengthy revenue cycle and less cash flow for the practice. With more responsibility being placed on the patients for these deductibles and co-insurances, practices can no longer survive with traditional billing processes. Many are starting to deploy new methods such as requiring patients to pay up-front for services when deductibles have not been met. Modifying collection practices is a systematic change for your business with many factors to consider and processes to work through. It is essential to plan and prepare to launch new policies.
Use data to determine if there is a need to modify your collection procedures. You may find there is no need to implement an entire new process for collections, but may want to consider new technologies to improve efficiencies or payment options to your patients.
Review your current policies and procedures. Does your process already include collecting deductibles and co-insurances? Perhaps there are polices in place that are not being enforced and simply require retraining staff and reinforcing the plan with your patients.
Review patient aging reports for A/R days and outstanding balances. If patients have balances that appear to be the entire cost of the visit, large balances or have a high number of days in A/R, chances are there is a significant amount going towards unmet deductibles.
If you feel changes are necessary, it's time to decide on an implementation date and which policies are you going to implement for your practice.
List out the steps for collecting at the time of service. Note what processes are already in place that will need to be altered, and which can remain.
Identify all the people who will be involved in the workflow and what they will need to manage their responsibilities.
Involve key staff in developing the new workflow; no one understands the job more than the people that are doing it each day. Having them become part of the implementation team will help them be more supportive of the program when it is rolled out.
If you are already verifying benefits prior to the visit, most of these systems will provide you with deductible information. Determine where this information obtained will be maintained in your management system.
If the desire is to collect co-insurances, obtain fee schedules for each plan and create a spreadsheet outlining your E&M Codes and top procedure codes.