There
are too many delays that can prevent timely reimbursement for your
claims. This, of course, causes cash flow problems. You may be able to
avoid them by reviewing your process at the following touch points and
making adjustments, where necessary:
Pre-registration
If
you have this in place, you can even obtain information when the
patient first calls for scheduling. This would include insurance
information so you can verify it. You could also get the SSN, driver's
license number, etc. That way the information is securely in your EMR
system.
Patient Visit
Make
sure you get good copies of the insurance cards. Review your form to
make sure it has been thoroughly completed and includes a thorough
financing statement. This needs to include when payment is due, late
fees, and any interest that will accumulate on the uncollected balance.
In addition, you might also detail:
- No-show fees
- Prescription refill costs
- Return check fee
- A fee if the co-pay is not made at the time of service
Make
sure the patient signs it. Make sure that they remit their co-pay or
prior balance before they leave. If they cannot, have your staff note
why the patient wouldn't or couldn't pay.
Completing Claims
Coding
and posting charges to the claims needs to be done in a secure, quiet
location. The tiniest error could cause the claim to be denied. You want
to shoot for 100% compliance in this area.
Submitting Claims
When
you submit the claim, it goes to a clearinghouse. Some of the more
prominent ones include PayerPath, RealMed and Emdeon. All of them go
through at least a cursory look at the submission to make sure
everything is present. Some may do a more thorough job than others.
Make sure you respond to their request for correction within 48 hours at the very latest.
Checking on Payment
Insurance
companies are not going to suggest that you use a system for making
sure a claim is paid in a timely manner. Establish a reliable follow up
system based on the contract and stick to it. Make it efficient. You can
usually follow up and obtain statuses on line. Take advantage of that.
It will be better for your office if you can check on 20 claims online
in the time it takes to check on two via the phone. Finally, if the
payments are too slow, make an appointment with an insurance company
rep. Make sure they are living up to the contract.
Reporting
Whatever
system your are using, make sure it has the flexibility to measure the
usual numbers (average days of receivable in 30 day increments, total
receivables, amount and percent collected, etc.). Make sure it can do ad
hoc reports for you too. In fact, if you are seeking a medical billing
company to do your billing and collecting for you, confirm that
reporting and extrapolating the data in a manner you understand is
absolutely one of their strengths.