Steps you can take to get paid more quickly
Tips for faster, more accurate payments
It is not uncommon for as much as 25% to 30% of physician office insurance claims to be delayed, rejected, or simply vanish in the black hole of an insurer’s payment office.
"Insurance companies are shafting us big time," says Gary Gotthelf, MD, a Pensacola, FL, internist. "It’s a major problem." Then there are those patients who fail to pay their fee-for-service bills.
"While physicians on average eventually receive about 98% of what they bill in payment, it often takes a while for the money to arrive," says David N. Gans, director of survey operations at the Englewood, CO-based Medical Group Management Association (MGMA).
However, a few relatively minor changes in your billing and collection procedures can produce big results in how fast — and how much — you get paid. Here are some payment enhancement tips from the MGMA and the American College of Physicians-American Society of Internal Medicine (ACP-ASIM):
• Know and follow the procedures.
It all starts with the basics. For instance, each payer has a different set of requirements for filing a claim. If you properly follow the set procedures, the claim gets paid. But if you overlook some seemingly minor items, the claim will be kicked back to you. Last October, for example, Medicare began requiring providers to note the full year — 1999 — instead of simply "99" in the claim date field.
One way to ensure your billing procedures are up-to-date is to keep separate notebooks of the latest guidelines from each payer that can be easily referenced and followed. Some experts recommend regular pop quizzes on recent procedural changes to ensure everyone is literally on the same page.
• Develop specialists.
Because it is impossible for one person to know all the rules, consider dividing claims among billing clerks by payer, says Elizabeth Woodcock, a Charlottesville, VA-based MGMA consultant.
For example, one clerk could be devoted full-time to Medicare, another to Medicaid and workers’ compensation, and a third to the Blues and commercial insurers. By concentrating on just one payer or payer type, a billing person can better understand that payer’s rules and know how to work the system when problems occur. And by developing a relationship with the payer, billing clerks often can get to the right people more quickly and in some cases circumvent bureaucratic rules, such as restrictions on the number of claims that can be discussed per call, advises ACP-ASIM.
• Update patient information regularly.
Filling out the right fields in a claim is only half the battle. An invalid policy number or the wrong identification number may be enough to get the claim kicked back. Thus, insurance and employment information should be verified for each patient every time the patient comes in for a visit, with any changes immediately keyed into the system.
• File early, file often.
The faster you file a claim, the faster you get paid. Some experts advise setting a filing target of within three to four days after service has been rendered.
Get checks in the mail daily
Others prefer to file more frequently. Frederick (MD) Internal Medicine, a four-physician practice, files its claims daily. "If I wait until the end of the week, I’m looking at 200 claims," explains Robin Laumann, the practice’s office manager. "If I file daily, there’s not as much paperwork. Instead of getting a check once a week from an insurer, I get checks daily. Our accounts receivable stays low."
• File claims electronically.
If you’re not already doing it, start filing as many claims as possible electronically. Moving to an electronic format can cut processing time from four to six weeks down to as little as two weeks. Some firms promoting electronic payment systems advertise the possibility of claims being paid before the patient leaves the office.
Even rejections are faster, generally letting you know within 24 to 48 hours if a claim has been turned down. This, in turn, permits you to correct the problem within days instead of having to wait for weeks to find out the paper claim was not considered kosher.
• Make sure the EOB is A-OK.
To increase cash flow, Brian Kane, CPA, president of HealthCare Advisors in Annandale, VA, suggests creating a tracking matrix with the main insurance companies you deal with across the top and the top 10 to 15 CPT codes on the left side. Fill in what insurers are required by their contracts to pay for these procedures; that way, billing personnel can check them against the EOBs.
You may be surprised to find many carriers are not fully honoring your previously negotiated fee schedule, notes Kane.
"Read your EOBs and make sure they’re paying you correctly," advises Sharon Pizzato, office manager for a Pensacola, FL, internal medicine practice. "Go back and fight for that five or 10 dollars they’re shorting you."
• Track claim denials by payer.
"See if you can spot a pattern," suggests David L. Warren, a CPA with Larson, Allen-Cherry Bekaert LLP in Richmond, VA. "A lot of times it could be the same mistake over and over again. If you don’t investigate, you’ll never know why you’ve been denied."
• Collect patient payments up front.
Insurance reimbursements are only part of the accounts receivable equation. Experts suggest that practices collect all copayments before the patient leaves the office. To avoid surprises, educate new patients about your policies as soon as they make an appointment.
• Go beyond the copayment.
Some practices collect the deductible and the 20% required by some fee-for-service plans. You can ask patients whether they have met their deductible; many know. To collect the 20%, create a grid of your top 10 CPT codes and the 10 most popular insurers so you know how much a patient will owe for a given procedure, suggests Jeffrey E. Davis, CPA, director of the Health Care Services Group of Glass, Jacobson & Associates in Owings Mills, MD. Keep the grid in sight at the front desk.
Pizzato’s office uses a "cheat sheet" that outlines the deductible and copayments required by various insurance companies. In addition, the numbers come up on the office computer system, alerting employees that a particular insurer, for example, requires a $10 copay on office visits and obliges the patient to pay 5% of the allowable charge for blood work.
• Multiple payment options.
Providing a variety of options — including credit cards — helps ensure payment. Some doctors don’t like credit cards because they charge a fee. "But for that 50 cents, you get the money up front," says Davis.
For those patients who regularly forget their wallet, give them a prestamped envelope to mail their payment in.