As patients face higher deductibles and out-of-pocket costs, practices need to have processes and tools in place that allow patients to focus on getting the care they need, help patients meet their financial obligations and ensure that both the patient and the practice do not place themselves at financial risk.
Below are some tips for practices to help enhance the collection process:
- Front desk staff needs to verify the eligibility of every single patient – and not just new patients. Practices should consider using a kiosk for collection of prior balances, setting up payment plans and capturing patient information up front.
- At the beginning of the year, review the practice demographic information documents and require patients to update demographic information and insurance information through paper or electronically. At the same time, make sure your practice has updated its financial policy and has a process in place to educate patients, so they understand the penalties or conditions around late arrivals, appointment cancellations, no shows, returned checks, credit card on file, payment at time of service, payment options and self-pay policies to name a few.
- Analyze your cancellation rate to understand why appointments were cancelled as every cancelled appointment causes decreased productivity and lost revenue. Once you understand why patients are cancelling (satisfaction, unnecessary appointment or provider-cancelled last minute), then your practice can modify internal processes, like possibly creating waitlist functionality or allowing patients to use your web portal to cancel and reschedule appointments.
- Improve your charge capture process – even if you already have an excellent rate, you may be able to improve a little. You can work toward a goal of timely charge entry by identifying and analyzing some of the data under:
- Date of service to date of documentation,
- Date of documentation to date of coding,
- Date of coding to date of charge submission (assuming the charge submission is the finalization of charge, including the clearing of all charge edits), and
- Date of charge submission to date of claim release.
- Total denials in your practice should be less than two percent. Business offices should be looking at the First Pass Acceptance Rate (FPAR) and their First Pass Resolution Rate (FPRR).
- Practices should also review their adjustment reasons and validate appropriate use. Adjustments are both contractual and non-contractual, in other words, adjustments that cannot be prevented and others which are under the practice’s control like submitting a claim for a provider who is not credentialed with a payer or not having the documentation needed for medical necessity. All adjustments that are within the control of the practice should be reviewed, discussed with the business office team and a plan created to prevent in the future.
- Reducing your days in Accounts Receivable to less than 30 days overall (better performers have 22-24 days in AR). If the number of days is higher, practices should investigate and determine the reason for the delay. Some of the reasons could be a slow payer or holds on claims because of an incorrect CPT code, or drugs that are new to market are not paid promptly.
This information was taken from an InfoDive webinar Accounts Receivable
, February 2019.