Overview & Recommendations
Office Contact: The revenue cycle process begins the day the patient contacts your office.
Billing Function: Well-versed billing and coding staff greatly impacts your revenue and A/R.
- Front office staff plays a critical role in the revenue cycle process.
- Clear concise communication with the patient is key.
- Staff understanding of the services your practice offers and a working knowledge of how the information that they gather from the patient impacts the billing process on the back end.
- Ensure that the demographic information you retrieve from the patient is complete and accurate. Transposing the slightest information can cause severe claims delays or claims denials.
- Don't miss the opportunity to collect the co-pay at the time of visit. Statistics show if you do not collect the co-pay at the time of service, you have a 50% chance of recouping that co pay later.
- Have your office staff verbally inform the patient regarding your policy on collecting co-pays and balances up front. This reinforces any posted notifications regarding payment expectations.
- Have a written policy regarding co-pays for the patient to sign off on, acknowledging that they understand.
Insurance follow up: Do not assume that "everything will be ok".
- Documentation is necessary and precision is critical. If it is not documented, it did not happen.
- Verify and confirm charges prior to the charge entry function.
- If you assign the codes, then the biller/coder should do a quick review of the documentation to ensure that the correct charges have been assigned based on the documentation that supports it.
- If there is a discrepancy with documentation, the biller/coder should review with the physician and have the guidelines handy to support any documentation shortcomings.
- If the biller/coder is entering multiple charges, understanding the usage of ICD-9 modifiers is key.
- Billers/coders also need to be familiar with the National Correct Coding Initiative (NCCI Edits).
- Correct/incorrect appending of modifiers will directly affect your reimbursement.
- Contact the insurance company within days of submission to confirm that claims were received and check on their status.
- Do not rely on confirmation of transmittal.
- If claims are denied, confirm the denial reason and draft a first level appeal. Depending on the denial reason, coordination between the biller/coder and the physician may be necessary.
- Become familiar with the payors appeal process. This will ensure that you are following the proper procedures to ensure that deadlines are met.
Payment Posting: Knowledge is Power!
- Familiarize yourself with your contract. Do you know how much your contract states you are reimbursed with your payors?
- Address discrepancies quickly. It is to your advantage for you and your staff to know what you should be paid.
- Avoid writing off charges that the Explanation of Benefits (EOB) does not direct you to write off.
- Audit payment postings frequently. Catch mistakes early.
Collections: The patient hasn't paid. Now what?
- Understand when it is OK to send a patient to collections.
- Learn the compliance requirements for sending a patient to collections.
- Clearly communicate your office policy regarding the collections process.
- Insurance companies place the burden on physicians and their staffs to educate the patient as to why they have to pay non-covered expenses with their services.
- Staff must be cognizant of their communication when working with patients on collections accounts.