Billing is way more than billing.
In a typical medical practice, more than 300 insurance cards cross the front desk every month. The variety of plans and coverage along with the complexities of coding and the difference among payers requires expertise and technology to effectively manage accounts receivable, regardless of practice size.
There are two basics required to manage your billing and accounts receivable — a practice management system and a clearinghouse.
The practice management system is the core patient registration, charge capture, and account management tool.
The clearinghouse provides connectivity to payers so that you can verify patient insurance eligibility and even determine if a service is covered or if the patient has met his deductible – all important to collecting the money due for the services you provide.
Of course, you can outsource your billing operation, and that can be very cost-effective. However, you will still need access to good eligibility information on your patients, or you’ll be sending your billing company garbage data, and you recall the old adage, “garbage in, garbage out”!
But billing is only part of your revenue cycle — and not the first part at that. The revenue cycle starts with patient registration.
Registration is more than getting the patient’s name and address right — you’ve got to verify that they have insurance that will cover the services they’ll be receiving.
Consider encouraging your patients to register in advance on your website via a patient portal. The portal service can automate the insurance eligibility process and deliver the resulting information to your staff for an expedited check-in process.
A kiosk in the office is another alternative that supports patient registration and automated eligibility verification.
To have a fully integrated system, ask your current practice management system vendor about these types of services.
Usually a patient’s insurance coverage comes with a copay that your office must collect – another before-the-actual-billing step in the billing process.
Be efficient and capture the copay when the patient comes in to the office. Doing so costs a lot less – and results in quicker payment than mailing a statement out after the fact.
Be sure to accept all forms of payment too.
It may seem expensive to pay the transaction fee for credit and debit cards, but there’s another old adage that “a bird in the hand is worth two in the bush.” There are even apps for your smartphone to read credit cards, so you can accept those copays at even your most remote satellite offices or offices that you visit infrequently without investing in additional equipment.
A kiosk may also offer the patient the chance to pay for their copay at check-in and it can prompt the patient about previous balances still outstanding.
Charge capture — another critical step in the revenue cycle — may be a hurdle in your practice. How are charges for the services you perform at offsite locations — hospitals, nursing homes, surgery centers — documented, collected, and transferred to staff?
Technology may be the answer if you’re using an electronic health record (EHR) to document visits; it can automatically generate the charge based on your documentation.
If you’re like the majority of physicians, though, and haven’t yet implemented an EHR, you could use a smartphone or the Web to capture charges offsite and automatically update your practice management system and/or your staff.
Ask your practice management vendor about charge capture tools available with your system or applications that have already been interfaced to your system.
After the claim has been generated and submitted electronically — finally, the actually billing — you’ll want to have the insurance remittance posted to your system electronically to save staff time. Use your staff resources wisely by having them follow up on outstanding claims, not doing the kind of data entry that computers can automate.
So, you see, billing isn’t just billing.
Get started on improving your process by performing your own internal audit of your billing operations.
Ask some leading questions to determine which processes are automated and which require too much manual intervention.
Additional services and tools will require an investment, but that investment will free up your staff so they can focus on getting your receivables turned over in 20 days instead of 30 or 40.
And that 20-day measure is absolutely doable.
Can your billing operation measure up to that kind of efficiency?
Rosemarie Nelson is a principal with the MGMA Health Care Consulting Group.