There's absolutely no doubt that, as a physician, you have had personal experience with payer hijinks. Ask any doc; he's got plenty of examples. But bellyaching alone won't get your claims paid. It helps to have a clear, unbiased view of the types of payer red tape that cause the most troubles and to employ effective strategies to circumvent the worst payer traps.How can you minimize the effects of payer traps or patient unwillingness to pay? Our experts recommend these strategies to collect all that you are due.To view these slides in PDF format, click here.
How can you minimize the effects of payer traps or patient unwillingness to pay? Our experts recommend these strategies to collect all that you are due.
Conduct an A/R review. Billing consultant P.J. Cloud-Moulds of Turnaround Medical A/R Recovery says it's vital to routinely review your A/R accounts; reconciling your charges against payer explanation of benefits (EOB). Claims can be skipped, denied, underpaid, or simply lost.
Upload payer fee schedules. Another tip Cloud-Moulds recommends is to know your fee schedules for each major payer. Many practice management systems will allow practices to upload payer fee schedules so that monies received can be automatically compared to contracted reimbursement rates.
Develop a process for working claims denials. It's important to set a billing policy and be consistent when working denials, says Cloud-Moulds. Every penny adds up, so it pays to be clear on when a biller should appeal a denial, and at what point your practice will begin to lose money by endlessly pursuing a claim.
Use online payer tools.Instead of waiting on the phone for hours, try using the tools that are available on payer websites, says David Doyle, CEO of CRT Medical Systems. You can check a denied claim online and find out what the status is. "The insurance companies ⦠developed these websites that do produce good results," he says.
Review payer contracts and end dates. Practice management consultant Owen Dahl says that involuntary enrollment in new healthcare exchange plans is a distinct possibility if a physician's contract contains an "all-nations clause." Another area to watch is evergreen contracts which automatically roll over year to year.
Educate patients. Working with patients to educate them on their insurance plans, particularly those with new exchange plans, will likely be your best protection against hard feelings and refusal to pay for services.
Create a patient financial policy. Draw up a policy that lets patients know you will collect all copays and deductibles at time of service, unless other arrangements are made. And don't forget to create a payment process for patients who have plans that carry higher annual deductibles.
Develop collection strategies. Pre-verify insurance coverage for all patients several weeks prior to their appointments. If possible, says Dahl, use a financial counselor, especially for high-cost procedures that may fall within the patient deductible.
