Too many doctors and practices obtain advice from outside consultants on how to improve collections, but fail to really internalize the information or understand why shortcomings can be so damaging to the bottom line of a practice, which is, at bottom, a business like any other. Here are some of the things you and your practice manager or financial team should think about when planning for the future:
Data Details and Insurance Verification
Some doctors are tired of hearing about this, but when it comes to managing medical A/R effectively, it often comes down to ‘data, data, data.’ Accurate data. Clerical errors at the front end can throw off automated attempts to bill and collect from patients. Lack of insurance verification can cause ‘black holes’ where amounts are routinely denied, and no pair of human eyes goes back to figure out why. These can cause a revenue shortfall that will leave you frustrated if you do not dig deep and truly investigate the issue.
One additional step you can take during the insurance verification process to offset a denial is to provide the anticipated CPT codes and or reason for the visit. Once you’ve established the initial benefits, you will also want to confirm limits and note the patient’s file. Because a patient’s plan may change, it is wise to check benefits each time the patient is scheduled, especially if there is a lag between appointments.
Debt Pile-Ups for Returning Patients
Another common issue in health care is the return patient who still hasn’t paid for past care. Too often, these patients breeze right past the front desk for additional doctor visits, procedures, and other care, without a single word about unpaid balances. Meanwhile, the paper bills, explanation of benefits, and statements, which often get thrown away unread, continue to pile up at the patient’s house.
Chatting about balances at the front desk is actually a service to both the practice and the patient. Without updates (in real time as opposed to on paper) patients will argue that they didn’t know a bill was ‘legitimate’ or whether it represented, for example, late payment by an insurer. Patients who get advised about their balances then have an opportunity to ask questions. One of the top reasons patients don’t pay? They don’t get to give input – it’s that simple. Medical businesses that want to thrive need to start having actual conversations with patients, to effectively close the ‘question gap’ and get the money flowing in.
The most basic principle behind medical A/R is time. Practices are, in effect, racing the clock. When bills go out on time, get updated on time, and get analyzed by staffers on time, there’s a much bigger chance that they will get resolved. Errors will get caught, and patients will see their balances shortly after they receive services. In other situations, bills just get older and older. Patients conveniently forget why they were supposed to pay, and can benefit from the vagaries of insurance billing with appeals and other obstacles. Practices end up paying a lot more money to get people to work aged accounts. In most cases, the simplest solution is best. Keep on top of patient financial responsibility, together with your patients, rather than just waiting for your money to trickle in.