Physiatry Practice Management Resources

Your appointment book is full and you are always seeing patients but your aging report shows that the services you are rendering are going unpaid.

This point of frustration leads to the need to analyze your current billing and collections process, whether you like it or not.

• Post Your Co-Pay Policy By posting the office collection policy for co-pays and deductibles, your patients know that you will require their payment at the time services are rendered. It is also a good idea to have your collection policies on the patient statement as well, so that they have a written copy of your policies with ever bill. If your policy states that payment is expected before the visit, be sure that you collect that payment so that your patients know you are serious about reconciling their account. Not following your own-posted policy will get you nowhere.
  
• Maintain Benefit Coordination Reconciliation One of the reasons many people don’t immediately pay, unless you collect the co-pay up front, is because they are waiting to see how much their insurance company will pay. While they wait, they are getting billed statements from their healthcare providers detailing recent submissions. If they do not receive paperwork on a recent visit, many will assume you have not submitted the claim to their insurance carrier and will not pay. A clear, easy-to-use billing statement, providing information that can be compared with insurance payments is a huge first step toward meeting the patient’s needs and expectations. Be sure that your account reconciliation for the patient reflects what the insurance company reflects for payment.
• Maintain Provider Registration/Credentialing Files A patient may be covered by numerous insurance plans. Because they have seen you many times, changes in their insurance may not prompt them to notify you that their insurance has changed. But what if you are not a member of their new insurance plan or your provider status has expired? How will you know? By maintaining credentials and provider status, you will be aware of an expiring or need for renewal status. In addition, if your client base continues to add insurance carriers, even for secondary payment, you will have contact information for contracting with new insurance carriers to provide services to an even wider range of patients, meaning greater opportunity to expand your practice.
• Interact Regularly with Insurance Carriers By staying current with changing insurance policies, your office will not be caught by surprise and be forced to resubmit large batches of claims because of a change in billing policy. If you are not actively collecting outstanding insurance claims, you are missing out on a vital interactive source for learning new insurance policies and billing practices. Making a commitment to collecting on insurance claims allows you to question insurance representatives of claims that are rejecting and any policies that may come through written notification. Staying aware of CPT and ICD-9 codes and the policies of each insurance carrier that is used by your patients ensures that patient claims will be processed correctly.
• Check Contact Information/Addresses Regularly Regularly checking the addresses of your patients and insurance companies prevents costly mail returns and billing errors. By maintaining contact information, a resolution to billing and collection problems can be easily corrected without facing more mail returns due to incorrect information.
• Be Willing to Create Separate Accounts In pediatric cases, typical divorce judgements include provisions that hold both parents equally responsible for the health care bills of their children. Try to gain an understanding of payments from both parents so that the bills for each child are sent to the correct parent and insurance carrier. If your practice continues sending bills to only one of the parents or the wrong insurance carrier, the parent who gets the bill can quickly find an account that is difficult to decipher and quickly becomes past due. The other parent, meanwhile, gets only information that is filtered through their ex-spouse, which can already be past due before an opportunity to reconcile is available.
• Provide a line-item-billing statement Avoid the use of traditional balance-forward accounting, in which payments made by patients or payers are applied to the oldest balance on the account. This makes it extremely difficult for patients to determine later what specific charges account for a particular balance that still may be due. Produce billing statements that are capable of telling patients on a line-by-line basis, which charges have been paid and which remain. There are many software packages that will allow you to customize the patient statement so that their statements clearly define what charges have been paid and what amount is outstanding.
• Be Ready to Appeal Denials Many practitioners would rather write off an account before having to submit their claims for an appeal process. Because so many physicians opt not to appeal denials, whether it is for the paperwork required or the added frustration of following the appeal, errors in the insurance carriers’ processing can go undetected, costing providers lost revenue. Be sure that all claims that are submitted have supporting documentation and are ready to be transmitted to fight for your money.
• Staff Training Be committed to your practice by offering regular training for your staff about changes that affect coordination of benefits, including federal regulations as well as policies by major insurance carriers to your practice. Assuming that your office staff "should know" about policies that are new can be costly.
• And the most important step towards better receivables… Utilize Electronic Billing Many physician offices still use paper claims to submit patient visits to insurance carriers. With floor times being mandated for paper claims, as well as the lack of proof that the insurance carrier received the claim, paper claims cost your practice a greater percentage of your earned revenue than investing in an electronic billing software package. If your office still utilizes paper claims, you are incurring fixed costs everytime you submit a claim. By switching to electronic billing, your office will operate seamlessly because all of the patient billing information is contained within a software program, instead of pulling paper files to sort for the appropriate information. Generating claims takes significantly less time and you will receive a confirmation code for all bills submitted electronically. Add the claim confirmation receipt to a typical turnaround time of 14 to 21 days for payment of claims and electronic billing pays for itself.