| Efficient Billing and Collections |
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Expert advice on Medical Billing & Collections Making sure your cash is flowing is more important than ever now that insurance reimbursements for many medical services have declined. Billing efficiently and improving collections are two ways to accomplish that. First, make sure your staff is well-informed on the specifics of your billing and collection policy, says practice management consultant Jack Valancy in Cleveland Heights, Ohio. Perhaps even more important is communicating the practice's payment policy to patients. "In the absence of this clear communication, most patients will assume the policies that are most convenient to them," he says. Mr. Valancy likes communicating the payment policy when new patients call to make an appointment. This means they won't be surprised or unprepared when a staff person asks for payment after they've seen the doctor. While some offices display signs explaining that payment is due when services are rendered, Mr. Valancy says this is not the most professional way to communicate the message. In addition, signs don't work, he says. "Patients aren't going to comply with them." Signs also send a negative message, namely that the doctor cares more about money than patients, he adds. Practice management consultant Donald DeMuth, a partner in Donald L. DeMuth Professional Management Consultants in Camp Hill, Pa., likes communicating the payment policy in a patient-information brochure. It's a good idea to have a professional brochure designed that spells out your payment requirements, he says, and be sure every new patient receives one. Medical practices will want the policy to clearly state that all fees and copayments are expected at the time of service. With managed care, virtually all patients will have a copayment. As a result, it's more important than ever to collect these $5 or $10 amounts at the time of service, rather than sending out bills, says Mr. DeMuth. Patients must realize that they are responsible for paying their portion of the charges and that you'd rather not have them wait until the insurance company has paid what it is going to pay, he adds. If the patient is scheduled for a major procedure, go over specific payment arrangements with the patient before the procedure is performed. Most patients are more willing to pay before treatment than later, when they feel better, practice management consultants maintain. You can mail new patients the patient-information pamphlet and keep a supply in your waiting area. When sending out the brochure, be sure to include a questionnaire on health history, insurance data, demographics and employment information that you want the patient to complete before the visit. Mr. Valancy recommends interviewing the patient to obtain this information so it will be as complete as possible. This also is a good time to take a photocopy of the patient's insurance card and to obtain names and phone numbers of principal contacts at third-party payers. All these steps help facilitate your collection effort. Be sure you update relevant information on a regular basis, because insurance information and home addresses may change. Know the Rules You may want to designate someone on your staff as an in-office patient-accounts representative to interview patients. This individual should be knowledgeable about collections and your office policies. They should also understand the charges for surgery, other medical procedures, and any facility and ancillary costs. In order to properly collect copayments from patients and know exactly what you are entitled to receive from the carrier, the patient-accounts representative has to be especially well versed in the details of the various insurance plans with which your office deals. He or she should review reimbursements from carriers to be sure the office is paid on time and receives the full reimbursement to which the practice is entitled. Your staff person should be well prepared to appeal any claim denials or downgrades. Each insurance plan has a provider-relations department. Stay in touch with that department and take advantage of the various resources offered, such as newsletters, manuals and seminars. It's a good idea to establish a good working relationship with several specific individuals at each carrier. This helps you avoid getting transferred from one representative to another when you have a problem, says Mr. DeMuth. Another important element of an effective billing system is doing the proper coding for the services performed. "The doctor should be aware of the appropriate CPT codes for his or her specialty and any documentation requirements," Mr. Valancy explains. This is especially important for Medicare claims, he adds. The encounter form or charge slip for each patient should always include the most common procedures for the physician to check and it should contain the correct diagnosis. "If you don't have the correct diagnosis, you won't get paid by the insurance carrier," he explains. After the patient has seen the doctor, it is important to be sure that the patient with his or her medical file are shown to the cashier so that any copayments or other charges can be collected. Don't let them leave without seeing the cashier, Mr. Valancy stresses. This also is a good time for the cashier to see if the patient has a previous balance and to collect not only the current charges, but any outstanding ones. Giving the patient the option to pay by credit card also facilitates collection, he says. While it costs money to set up a credit-card account, it is well worth the expense. "It makes sense to get your money today as opposed to having your staff go through the work of producing the bill and then waiting for payment," he maintains. Credit cards also allow you to set up patient-payment plans for large balances. Past-Due Accounts If you are still left with delinquent accounts, practice management consultants say there are additional ways to collect what you're owed. Generally, an account is considered delinquent if you can't collect the outstanding balance after 90 or 120 days. Be sure your staff takes the time to identify these delinquent accounts, and that you review them to decide whether or not there is a reason not to collect what's owed. "The doctor knows the patient best and he or she may know something about the patient that the staff person doesn't, such as the fact that the patient may be in the middle of treatment for a serious illness," Mr. Valancy explains. After the doctor gives the go-ahead, the staff person should start to call patients and ask about payment. Calling is more effective than writing, Mr. Valancy says, adding that you get better results "with honey than you do with vinegar." Your goal is to have the patient make a promise to pay and be able to work out a specific payment plan that the patient is able to meet. If all else fails, you can seek the help of a collection agency. If
you use a collection agency, keep in mind that it really can't do more
than your medical office can, says Mr. DeMuth. In addition, you will
have to pay them about a one-quarter to one-half of the amount they are
able to collect. "It is really a last resort," he maintains. The best
approach is to work out a payment arrangement that the patient and the
practice can accept. Written by Joan Szabo -------------------------------------------------------------------------------- How To Improve Collections When patients are scheduled for procedures, payment arrangements should be discussed when the appointment is made. Give patients the option of paying by credit card. Obtain updated insurance information on all patients. Be sure that all claims include the proper codes for diagnoses and services performed. Review reimbursements from insurance carriers to be sure the office is paid on time and in full. Be prepared to appeal any claim denials or downgrades. Follow up on all delinquent bills and claims.
Source: National Association of Healthcare Consultants Statistics Report for2004, based on 2003 data |
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