One of the best ways to ensure your practice remains profitable is to collect every dollar you are owed for the services you provide. Obviously, billing is a key component, and ensuring accurate billing and collections starts at the front desk because the tasks and processes initiated there have very real implications throughout the entire revenue cycle management process.
The following guidelines can help your front desk staff do their part from the beginning to help maximize profits in the end.
- Verify Eligibility and Benefits
This is the most critical step in the process so ideally it should be done at every visit. However, if that isn’t practical for your practice be sure that your team verifies eligibility and benefits at least with every new patient and at the beginning of a new calendar or plan year for active patients. This includes both primary and secondary insurances as applicable. About 15% of claims have to be worked after the fact to get paid and bad insurance information is the most common source of denials. That’s why it’s so important to verify and reverify as necessary.
- Do not skip this step. If you choose to, you’re most likely to learn of issues with eligibility when your claims are denied making it that much harder to get paid for the services you provided.
- Identify specifically who the billing staff needs to bill. It’s not always clear cut, so it is important to identify who needs to be billed especially when patients have both primary and secondary insurance.
- Develop a robust financial policy to ensure you collect every dollar you have earned and make sure that all patients sign forms indicating they understand the policy. The policy should state that patients are responsible for any portion not paid by insurance and include a statement that explains that attorney fees and other collections costs—should their accounts be referred for collection—will also be their responsibility.
All data entry must be accurate and should match what’s on the patient’s insurance card. Nicknames or other internally used names are irrelevant. The name on the claim must match the patient’s insurance card precisely.
- Know the difference between Medicare and a Medicare-replacement plan because this affects where claims are billed. This is a common mistake so your staff must be proactive in understanding the difference and take care that they are queuing claims correctly so that each claim goes to the correct payer the first time.
Generally, with surgical procedures or cases of workers’ comp and MVA/personal injury preauthorization is required. But it’s becoming more common that commercial payers and third-party administrators require preauthorization for physical therapy and various medical procedures as well. Failure to get a required preauthorization is a common reason that claims have to be worked after the fact to get them paid.
- Find out if preauthorization is required.
- Determine if the patient’s benefits are limited. For example, if physical therapy visits are limited you have to know the number of available visits that remain and you have to keep track of the care you provide. This way, you either stay within the limits or use the correct modifier if applicable, such as with the Medicare therapy cap.
- Choose an EHR that can track authorizations and visit limitations for you so you don’t waste valuable time providing services for which you may not be paid.
Collecting your patients’ co-pays, deductibles, and other out-of-pocket expenses prior to providing your services is critical. If you don’t collect prior to service you may never be able to collect at all. Regardless of why, there are unfortunately people who don’t pay their bills if you fail to collect from them upfront.
- Co-pays are fixed amounts and are easy to identify.
- Unmet deductibles also need to be determined and collected up front.
- Co-insurance should also be collected but it’s a bit tricky because the amount varies based on the services you provided that day and how much that payer allows for those services.
- Maintain credit card information on file for outstanding balances as this takes pressure off the front desk staff of trying to calculate how much to collect toward co-insurance or unmet deductibles. But be sure the data is properly secured. To be compliant with payment card industry (PCI) standards, you need to be able to know when a breach occurs. If a breach takes place, you need to know who was affected. There’s a lot of rigor that goes into keeping credit card information secure and in compliance with PCI requirements so it’s probably wise to work with an organization that can help you or work with a third-party vendor that provides credit card processing. Don’t do it on your own; it’s too much work and it’s too fraught with risk.
Maximizing the profitability of your practice is complex and multifaceted and making sure you implement the essential practices at your front desk to optimize your collections is the first key step in the right direction.
David Allen, MBA
As President and CEO of Flatirons Practice Management, David and his organization process thousands of medical claims and hundreds of thousands of dollars in collections every day. Flatirons Practice Management, through their rigorous policies and procedures, has been helping their clients maximize their collections for the past 20 years.