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For many practices, it can be difficult to collect all that they are owed. While this is often blamed on “billing errors,” the fact is, there can be many reasons why a business isn’t being paid. Before simply writing off bad debts, it is imperative that health care practices perform a self-audit in order to find out where the problem lies. In looking at the following questions, determine if the answer is yes, no or unknown.• Does your practice collect payments equal to or greater than 90 percent of the collectable (net charges)?
• Do you verify insurance eligibility prior to every ambulatory care service?
• Do you verify eligibility and determine pre-authorization/referral as needed for all inpatient services (consults, procedures, surgeries)?
• Do you know when co-pays are due and collect them at the time of service?
• Does the practice collect cash each day?
• Do you have management reports that enable you to review the quality of your staff’s registration data?
• Does the staff believe that the registration data is accurate and high quality?
• Are your claims rejected by the payer less than 10 percent of the time?
• Does your practice offer credit cards as a payment option at all sites and on patient statements?
• Do you feel confident that the staff/physicians know what contracts the practice has and what the critical components of those contracts are to ensure compliance and reimbursement?
• Are your patient statements easy to read and informative?
• Are your days in A/R in line with best practices?
• Does your practice capture the referring physician for each service provided?
• Does your practice review a patient’s account for previous balances prior to his or her appointment and inform the patient?
• Does your payment posting staff track rejections and provide feedback to front-desk staff?
If you have more than four ‘no’ answers, chances are, you could see a significant improvement in your cash flow; if you answered ‘no’ to more than 10 questions, making changes in your billing process could help you see a dramatic change.
There are a number of factors that can contribute to a weak billing process, ranging from aging accounts receivable not being worked, to staff doing duplicative tasks or having trouble dealing with a large volume of incoming mail. Other factors can include a delay in billing to secondary patients; patient statements being delayed because balances aren’t posted; numerous denials for duplicate claims or authorizations; not having a denial tracking system, or large dollars sitting in suspended claims. Communication issues can include the front desk staff having no information about denials or delays, few outgoing calls to payers or a backlog of unanswered correspondence from payers requesting more information.
In order to clean up the cash flow process, a practice should establish dashboard indicators to monitor a number of factors. These include the percentage of accounts receivable that are over 90 days; the registration accuracy error rate; the percent of denials due to referrals and the daily amount of cash collected, among other benchmarks. By comparing these numbers to ‘goal’ benchmarks, a practice can better target areas that need work or areas in which staff need further training.
It is also important to establish a system of reports that enable the practice to monitor current activities in order to predict outcomes and better make decisions. Information should be included for the whole group as well as individual physician/providers, and include information on charges, contractuals and payments for each payer individually as well as for the group.
While cash flow for every practice is different, many health care providers make the same mistakes in the collections process. This can include not having a financial policy in writing; letting patients fail to complete the patient information form; staff not asking for payment; failure to fully utilize credit cards; making unacceptable payment arrangements; waiting too long before assigning accounts to a collection agency; not prioritizing follow-up calls and tolerating payer’s stall tactics.
Once you are able to specifically target the reasons why your practice is having trouble collecting the money owed to it, and create solutions to solve these problems, you can dramatically make a difference in how your practice bills and collects money and see an improvement in your bottom line.
