Over the course of a few years now, I've been writing a blog article for Physicians Practice. One of my very first articles was called "Lifecycle of a Single Claim" and it followed one single date of service through an entire life cycle. It started from the time the patient called in to the point the payment was posted, and if necessary, a bill was generated and sent to the patient for payment.
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What has happened over the course of a few years is this document has become the center of our entire billing process, and has grown and morphed into a living document that changes frequently. I have found this document serves multiple purposes. First, if you do not have a document like this, it's a really great idea to make one. It could look something like this:
1. Patient calls in to make appointment.
2. Front office takes down pertinent demographic information
• First and last name
• Date of birth
• Insurance policy number, subscriber, and subscribers' date of birth
• Telephone number
• Fax, e-mail address, or mailing address to send new patient paperwork
3. Front office schedules patient
4. Front office explains cancellation policy
5. Front/back office verifies medical insurance
• If incorrect policy number provided, front office calls patient back for updated information
6. Front/back office enters patient data into computer system
7. Patient arrives for appointment
8. Front office gives patient an explanation of insurance benefits as provided by the insurance company
• Front office explains payment policy to patient, stressing that the insurance benefit information provided to them may change, and the patient is ultimately financially responsible for all charges.
You can see the detail necessary to make sure every area that could cause any type of delay or denial is covered. The document I use is 17 pages long, so the more detail you include, the better your chances of claim payment success.
Once you have a full document of steps that are needed to follow a claim through your billing cycle, this becomes your process. If you have an employee who goes out for a vacation, or is sick, and you have a fill-in, this process then becomes the backup for the staff member who will perform the tasks of the front/back office, data entry, insurance verification, the payment poster, and the claims follow up person. This is your golden ticket. I have always said that everyone should know everyone else's job from an administrative standpoint. This is so that no one, single employee can hold you hostage because they are the only one who knows how to do their job. I call this full transparency. Good employees who care about your company will fully support this process. If you end up with someone who disagrees with this transparency, you might want to review his or her motivations.
This document also serves as a training source for new employees. If you choose to allow a new employee to shadow other staff members, she may become confused because each person who trained her has a different method and process for performing the necessary tasks. With a written document that spells out procedures, everyone performs the tasks the same way, and this cuts down the opportunity for a payment delay or claims denial.
Overall, I continue to utilize this document and hone it on a weekly basis. Anytime we find there is an opportunity to update, modify, and create a better process, we do. It only makes the group stronger, smarter and always on the same page.