Coding Strategy

5 tips help you recover deserved pay.

Collecting money from patients, especially during a recession, can be challenging. If your front desk is responsible for collecting copays and sometimes old balances, its success or failure has a dramatic impact on the practice’s bottom line.

Check out five ways you can improve your front desk collection efforts:

1. When calling to remind patients about their visit date, also remind them of their co-pay amount and any old balances so they come prepared to pay at the visit.

2. When a patient complains about paying a bill, send her to a manager so the bill can be reviewed and explained.

3. Most practice management software will allow front desk staff to view outstanding balances. Your front desk staff can politely remind the patient that there is a balance and say something like, “How would you like to pay your bill today?” Assume that the patient is planning to pay.

4. If the patient has a problem paying their balance or paying for the visit that day, do not discuss this at the front desk. Respect his privacy. Staff may wish to take him to a manager’s office where a payment plan or other arrangement can be established.

5. Ask your manager about offering discounts to patients with no insurance if they pay for the visit at checkout instead of sending them a bill.

And one extra tip: Involve Your Supervisor. Pearl Stafford, front office manager for an internist and gastroenterologist in Naples, FL, who also once worked for a psychiatrist where she assumed the role of the receptionist from time to time, acknowledges that old or really old AR can be difficult to collect. “A lot hinges on the physician,”says Stafford. “In this particular office, my physician provided incentive. Since the AR was so old in many cases, he offered me 25 percent of anything I collected. Most collection agencies charge 50 percent, so this was beneficial to the practice and also worked as an incentive for me.” If something is really old, it’s better to collect some money as opposed to nothing and wipe it off the books.

Carol Gibbons, CEO of CJ Consulting, helps management to set up collection targets for the front desk and then rewards staff when they reach that goal. “In one practice with seven physicians, the front desk as collecting $500 per day at the front desk. After doing training with the front desk staff, we started pushing up their collection goal and then bought lunch each time they reached a new goal. Today, at the front desk, that office collects $2,500 to $3,500 per day in co-payments, co-insurance, and old balances. The manager still buys pizza when they reach a new high in daily collections or rewards individual employees with gift cards.”

Again, your specific role in collections will vary, but these are some ideas that you may wish to present to your manager or physician if they are not yet implemented in your office.

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This 3-step checklist will boost your bottom line.

With fewer patients following through on procedures because of economic and financial struggles, and an increasing number of patients not paying their bills, your practice needs to find ways to improve your A/R and bring in deserved money. Adapting an up-front deductible collection policy is one proven way to do both — and setting up a policy can be as easy as 1-2-3.

1. Confirm the Deductible With the Payer

Insurance verification services now make it possible for practices to find out if a patient has met his deductible yet. Some services can tell you how much of the deductible remains unpaid. Because this information is available online, your practice can get this information last-minute, the day of, the day before, or several days before the patient is scheduled to come in for a service or procedure.

“I have started to look up insurance deductibles and copays on Web sites,” says Joy Bloodworth, CPC, CCS-P, office manager and coder for Surgical Associates in Cordele, Ga.

Pointer: Check with your benefits verification services, as some offer real-time information on how much of a patient’s benefits have been used to date, the deductible to date remaining, number of hospital days remaining, skilled nursing facility (SNF) days remaining, and if the patient has Medigap coverage that will cover a portion of the payment.

2. Contact the Patient Before the Procedure

Once you have the information from the payer about what the patient’s responsibility will be, you should contact the patient. Most practices are more successful when they contact the patient several days before the procedure, rather than the day of the procedure, experts say.

“We are calling patients about one to two weeks in advance if possible requesting the deductible or their percentage of the allowable of their insurance for the procedure being performed,” says Lori Owens, CPC, CGIC, insurance supervisor at Ohio Valley Surgical Specialists in Owensboro, Ky. “It is working fairly well.”

Be clear: Make sure you tell the patient where you got the information about her deductible and let her know that the amount is an estimate based on the services your physician expects to perform, Bloodworth cautions. Otherwise, you may get calls from patients after procedures “saying they paid up front and don’t owe any more after the insurance pays,” she says. “When I get the information from the insurance company, I tell the patient it is just an estimate and after insurance pays we will adjust the payment form accordingly.”

3. Consider Rescheduling When You Can’t Collect

If you cannot collect up front from a patient, you’re left with two options: Cancel the procedure or perform the procedure and hope the patient pays you afterwards when you send a bill.

“If there’s no emergency, we ask that the patient pay the copay and deductible up front,” Bloodworth. “We will reschedule if the patient does not have it and the physician says it is elective.”

Some patients may get upset that you’re asking for their money before you perform a service, especially if they don’t feel they can pay their deductible. “We feel that these patients would probably not pay anyway and it makes room for patients waiting to have procedures performed,” Owens explains.

Other patients, however, may simply need additional time to pay you. Even when you don’t collect up front, making an attempt can still help you collect eventually. A patient will know before having the procedure exactly how much she will owe your practice.

“You may not collect from all,” Owens says. If her practice doesn’t cancel the procedure, the call “just lets the patient know how much to expect” when the practicesends a bill.

Set up a payment plan: Some patients cannot come up with the entire deductible amount up front and will ask to make payments, Bloodworth explains. “They have to come up with at least half of it and sign a form showing the balance due and payments less than $200 will be paid by three months and over $200 will be paid by six months.”

Bottom line: At least attempting to collect deductibles up front is beneficial for your practice. “Our A/R is more in line now and we definitely have seen a difference,” Owens says. “It is worth the hassle.”

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Pay attention to EOBs and keep talking to your MAC.

You could be losing money to a computer glitch and not know it, experts say.

If you don’t nip a computer glitch in the bud, you may be plagued with improper denials and other claim holdups. Here are seven things you can do to seek out and solve glitch-related problems:

1. Eyeball Your EOBs

Watch your explanation of benefits (EOB) forms, and keep your eyes open for denials and downcodes that don’t look correct.

2. Check Your A/R

Always review your accounts receivable (A/R) to ensure that you’ve received the payments you’re due. If a computer glitch kept your MAC from paying you, don’t hesitate to point it out to the payer.

“If we have any claims outstanding for 30 days that we sent electronically to that carrier, we contact the carrier right away,” says Ginny McManus, billing manager with Berger Henry ENT Specialty Group in Pennsylvania.

“If we are told there is no record of receiving the claim(s), we will rebill immediately,” McManus says. “It is definitely up to the practice to catch these problems. I have run into this scenario before and the carrier has never automatically reprocessed any of our claims. Good follow-up is everything in a billing department.”

3. Don’t Blindly Believe MACs

If you contact the MAC and the representative tells you that the payer plans to reprocess all claims affected by the glitch, always recheck that they’ve followed through.

“Once I’ve submitted the claim, I will have our collector call back in two days to see if the claim has been received by the payer,” says Kathy Philp, CPC, director of billing with Praxis Health Group in Oklahoma City. “I have the collector explain to the representative that they have by law to pay within a certain timeframe, which is usually 30 to 45 days, depending on the state.”

4. Keep Timelines in Mind

In many cases, the insurance company will not reprocess the claims, and you’ll have to resubmit them. “In that case, I would have the collector speak to a supervisor to find out whether they will deny the resubmitted claim as a duplicate, which would cause further delay in payment,” Philp says.

Philp recommends calling the insurance companies two to five days after electronic submission. “Even if the claim goes to your clearinghouse, that doesn’t mean it has gone out to the insurance company, because claims usually go to another clearinghouse before they get to the proper insurance company,” Philp states.

“Collectors should understand how the submission to a clearinghouse really works — claims are submitted to other clearinghouses and insurers.”

If the MAC experiences a computer glitch, “then you need to follow the trail to find out where it started — was it during transmission, or is the insurance company stating this as a stall tactic and delaying payment?” Philp says.

5. Rely on Web Resources

Watch your carrier Web site. Some carriers that have experienced computer glitch problems have put up “error resolution reports” on their sites. You can look up each problem and see an estimated date for repair. If that date has passed, you should resubmit any claims affected by that glitch.

6. Tackle Snags in Person

Visit your CMS regional office if necessary. If the carrier is denying or downcoding claims improperly and isn’t responding to your complaints, you should take the matter to your regional office of CMS.

7. Stand Firm

When you contact your MAC, make sure you get all of the information you’re seeking before you end the conversation. “I would recommend to anyone trying to collect from their insurer to be firm but nice and don’t let them run over you, because they will if they think they have the upper hand,” Philp says. “It is sad that we have to fight so hard to get the money that is owed to us.”

© Part B Insider. Download your 2 FREE sample issues here.

Friday Funny: Say CMS 3 times fast. Do you hear ‘SEE A MESS’ like I do? Master the madness at the 2010 Healthcare Billing & Collections Conference in Orlando, December 6-8.

Related articles:

1. Coders: Watch Out for Claim-Denying Computer Glitches Don’t wait for your MAC to alert you to...
2. Medical Office Billing: Benefits Verification, Copayment and Consolidated BillingIs Lack of Verification Costing Your Practice? Stop the Bleeding...
3. Make Even Problem Payers Pay Up With These Tips From 2 ProsFollow this 3-step path and get results from every payer. At...

Pay attention to EOBs and keep talking to your MAC.

You could be losing money to a computer glitch and not know it, experts say.

If you don’t nip a computer glitch in the bud, you may be plagued with improper denials and other claim holdups. Here are seven things you can do to seek out and solve glitch-related problems:

1. Eyeball Your EOBs

Watch your explanation of benefits (EOB) forms, and keep your eyes open for denials and downcodes that don’t look correct.

2. Check Your A/R

Always review your accounts receivable (A/R) to ensure that you’ve received the payments you’re due. If a computer glitch kept your MAC from paying you, don’t hesitate to point it out to the payer.

“If we have any claims outstanding for 30 days that we sent electronically to that carrier, we contact the carrier right away,” says Ginny McManus, billing manager with Berger Henry ENT Specialty Group in Pennsylvania.

“If we are told there is no record of receiving the claim(s), we will rebill immediately,” McManus says. “It is definitely up to the practice to catch these problems. I have run into this scenario before and the carrier has never automatically reprocessed any of our claims. Good follow-up is everything in a billing department.”

3. Don’t Blindly Believe MACs

If you contact the MAC and the representative tells you that the payer plans to reprocess all claims affected by the glitch, always recheck that they’ve followed through.

“Once I’ve submitted the claim, I will have our collector call back in two days to see if the claim has been received by the payer,” says Kathy Philp, CPC, director of billing with Praxis Health Group in Oklahoma City. “I have the collector explain to the representative that they have by law to pay within a certain timeframe, which is usually 30 to 45 days, depending on the state.”

4. Keep Timelines in Mind

In many cases, the insurance company will not reprocess the claims, and you’ll have to resubmit them. “In that case, I would have the collector speak to a supervisor to find out whether they will deny the resubmitted claim as a duplicate, which would cause further delay in payment,” Philp says.

Philp recommends calling the insurance companies two to five days after electronic submission. “Even if the claim goes to your clearinghouse, that doesn’t mean it has gone out to the insurance company, because claims usually go to another clearinghouse before they get to the proper insurance company,” Philp states.

“Collectors should understand how the submission to a clearinghouse really works — claims are submitted to other clearinghouses and insurers.”

If the MAC experiences a computer glitch, “then you need to follow the trail to find out where it started — was it during transmission, or is the insurance company stating this as a stall tactic and delaying payment?” Philp says.

5. Rely on Web Resources

Watch your carrier Web site. Some carriers that have experienced computer glitch problems have put up “error resolution reports” on their sites. You can look up each problem and see an estimated date for repair. If that date has passed, you should resubmit any claims affected by that glitch.

6. Tackle Snags in Person

Visit your CMS regional office if necessary. If the carrier is denying or downcoding claims improperly and isn’t responding to your complaints, you should take the matter to your regional office of CMS.

7. Stand Firm

When you contact your MAC, make sure you get all of the information you’re seeking before you end the conversation. “I would recommend to anyone trying to collect from their insurer to be firm but nice and don’t let them run over you, because they will if they think they have the upper hand,” Philp says. “It is sad that we have to fight so hard to get the money that is owed to us.”

© Part B Insider. Download your 2 FREE sample issues here.

Friday Funny: Say CMS 3 times fast. Do you hear ‘SEE A MESS’ like I do? Master the madness at the 2010 Healthcare Billing & Collections Conference in Orlando, December 6-8.

Related articles:

1. Coders: Watch Out for Claim-Denying Computer Glitches Don’t wait for your MAC to alert you to...
2. Medical Office Billing: Benefits Verification, Copayment and Consolidated BillingIs Lack of Verification Costing Your Practice? Stop the Bleeding...
3. Make Even Problem Payers Pay Up With These Tips From 2 ProsFollow this 3-step path and get results from every payer. At...