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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Verify co-pay early to save time, money

Question: A patient came to our office for a routine exam with the same insurance card she’s had for years. We charged her the standard copay of record. Then I found out her employer changed the terms of the insurance, so the copay she paid was short by $20. What went wrong?

Answer: You might easily assume that when a patient has the same insurance company, the copay is the same as it has always been. But unless you check first, you won’t know the patient’s coverage has changed until after the fact.

Best practice …Set up a process to verify each patient’s insurance information before every visit. The ideal time to verify with a patient or her insurance company is either before the appointment or when she arrives at your office. Devise a plan for how you will obtain patient information early on. Your options include connecting with the patient, a software program, or through the payer directly.

Finally, copy every patient’s insurance card every time. This simple step will put you in the clear for those times when a patient’s terms, copays, or precertification contact numbers have changed.

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Participation can put extra bread in your basket.

Back again for 2010 is Medicare’s incentive-driven physician quality reporting initiative (PQRI), aimed at tracking quality metric or patient care services that physicians provide. When the practice treats enough patients in the same category, some PQRI dollars might be only a few codes away.

If you know the basics and focus your efforts, PQRI reporting can be a breeze and a boon to your bottom line.

Anyone confused about PQRI — or with questions about setting up a PQRI program in a specialty setting — should go immediately to the CMS PQRI tool kit.

Where? Check out the tool kit here.

“This kit includes valuable resources to assist eligible professionals in the successful integration of PQRI measurement into their practice. CMS suggests that eligible professionals review and discuss the following materials with their staff,” Medicare says.

The kit lists three PQRI “tools” designed to help practices comply with PQRI:

1. 2009 Implementation Advice for 2009 PQRI and E-Prescribing — A publication that introduces the coding and reporting principles underlying successful PQRI reporting.

2. 2009 PQRI Code Master Single Source — A numerical listing of all codes included in PQRI intended for incorporation into billing software.

3. 2009 Data Collection Worksheets — You should use measure-specific worksheets that walk the user step-by-step through reporting for each measure. “These worksheets may be used by the practice on a concurrent basis to collect PQRI data,” CMS says.

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Want to know what RAC contractors will be looking for next? Here’s the link.

Recovery audit contractors (RACs) are working hard to expand their lists of approved issues, and you should keep a close eye on your services in these areas as well.

Health Data Insights (HDI), the RAC contractor for Region D, posted 66 new approved issues for review in January, with the following just a small sample of what HDI plans to review going forward:

• Global surgery pay versus technical component (TC)/professional component (modifier 26) and

• New patient versus established patient cases.

Keep in mind: When a RAC lists its open issues, it also lists the applicable states where it is reviewing them. Some issues are under review for all states that fall into a particular RAC’s purview, while others may be applicable to just one or two states.

Bottom line: To stay on top of the issues that your RAC is reviewing, check in on the applicable Web site from time to time.

To learn more about what the RACs are doing in YOUR region, go here.

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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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Available on CD: Billing & Collections Reference Pack, Updated for 2010. Buy individual recordings, or purchase the entire series for a discount.

Related articles:

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