Tips for efficient billing and collections

October 27, 2010
Ronald Piana

Surveys have shown that the mean days in accounts receivable for US oncology practices averages about 36 days. With today’s slim margins, your AC department needs to do a better job.

Surveys have shown that the mean days in accounts receivable for US oncology practices averages about 36 days. With today’s slim margins, your AC department needs to do a better job.

 Here are are a few quick and easy-to-initiate tips:

Verify insurance information and authorization

The practice should have standard procedures to confirm insurance coverage and verify that the patient has obtained any needed referral. Management experts suggest preregistering new patients by phone because of distractions at the reception desk that can lead to errors. Preregistration also allows the staff to verify insurance coverage with the insurance plan in advance of the patient's first visit.
Confirm accuracy of demographics and insurance.

If a preregistration process is in place, ask arriving patients to review the information collected to check its accuracy. At the first visit, copy the insurance card, and make sure the identification number and name exactly match your office record-no nicknames, for example.

Collect copayments and deductibles at time of service

The amount of patient copayments and annual deductibles is rising, adding to the importance of collecting them promptly. Collecting from the patient in person obviates the overhead costs of billing and enhances cash flow. For cancer patients, the services rendered and therefore the copayment amount may not be known until after the physician sees the patient, so set up the process for collection at the end of the visit.

File claims daily

In addition to starting the payment process more quickly; daily billing reduces the effect of a potential submission problem such as a transmission disruption or a lost packet of mail. If claims are batched by the week or month, such an adverse event could affect a large portion of income.

Submit claims electronically

Electronic submission is the trend, and for good reason. Electronic claims are processed faster than are paper claims, and fewer electronic claims result in denials. According to a 2003 survey by the Health Insurance Association of America (now America's Health Insurance Plans), 97% of physician claims submitted electronically were clean, compared with 89% of paper claims.

The processing of electronic claims is faster, too: in a 2009 survey by America's Health Insurance Plans, 69% of clean electronic claims were processed within 7 days, compared with only 29% of clean paper claims.

Use an electronic claims scrubber

A number of software products and online tools are available that will check claims for errors. Some check only for generic errors such as ZIP codes with six digits or a day of the month that is greater than 31, whereas more sophisticated scrubber programs check for required prefixes or suffixes in patients' insurance identification numbers and have edits to check compliance with Medicare's Correct Coding Initiative.

Your practice management system may have a built-in scrubber module that incorporates all of these edits. If it does not, discuss options with your software vendor to find the right add-on program or Web-based service for your practice. If you use a service bureau for billing, find out what its claims-editing software includes. Practices that put effort in submitting clean claims, including using a sophisticated claims scrubber, report achieving denial rates of less than 1%.

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