Getting Money in the Door: Streamlining Patient Collections

I was recently invited to share my expertise on improving physician practice revenue with Physicians Practice, one of the foremost editorial authorities in practice business operations.

As with any communication, I focused on my audience when writing this piece. The readership of Physicians Practice is a mix of both the doctors providing the clinical care and the physician practice managers keeping the business operations running. While these are two separate parties (in rare instances, yes, one in the same), they must work collaboratively to achieve successful end results. Sometimes, that can be reached by outsourcing some of the most time-intensive tasks including accounts receivable.

At ClinicSpectrum, we offer the easiest and most comprehensive way to tackle any issues specific to insurance claims:

  • We handle electronic and paper/HCFA claims. Despite paper claims seeming to taper off with the speed of technology adoption, we can handle both appropriately.
  • We are speedy. Electronic claims should be followed-up on no less than 10 days after they are submitted to the insurance company. Any less time, and it’s likely the claim hasn’t been reviewed and filed appropriately. Any more time, and the likelihood of the claim getting “lost” or being perhaps incorrectly denied increases greatly.
  • We have numerous avenues for follow-up. If the company doing follow-up only has one way of contacting the insurance company, do you think they will be aggressive in collecting what is owed to you in a speedy fashion? Probably not. We follow-up via online, phone and other interactive ways of reaching insurance companies to get to the bottom of why a claim has been denied or unpaid.
  • Lastly, once a claim is addressed, yet still unpaid, we can help you do what is needed to achieve a positive end result.

Not unlike insurance claims follow-up services, physicians practices can look to companies specialized in this area to follow-up with patients to collect balances owed. ClinicSpectrum can help with this too:

  • We have automated solutions. Automated collection software can be installed and managed by practices to relentlessly – within regulations – contact debtors to increase collection rates.
    • We automate the traditional collection methods of standard mail delivery and costly representative phone calls, to a more elaborate, seamless, cost-effective auto collection process.
    • We use automated collection methods using technology platforms, decisions rules and messaging such as text, email, push notifications on smart phones and automated calls to allow seamless, consistent results for balance collection.

I encourage you to take a read of my entry with Physicians Practice, published on 22nd August. I hope it serves as a helpful resource to show you what measures can be taken to achieve one of the most important business goals: getting money in the door.

As always, I welcome your feedback and any additional commentary. Feel free to leave a comment or contact me to discuss further at

Needless Ways Your Practice Is Losing Money

bank-notes-bills-buy-2114-723x550Did you know that between 2009 and 2012, insurance denials for claims for reasons like inclusive procedures, not meeting medical necessity, required medical documentation, among others, has increased by almost 37 percent? Additionally, did you know on average, 32 to 35 percent of claims can go unaddressed for lengthy periods of time costing practices real money? Should we even mention patient responsibility for one claim visit has increased from approximately $12 to $30 on average?

It’s as if getting money in the door for your practice has become increasingly impossible. If it’s not one thing keeping you from healthy revenue, it’s another.

While we at ClinicSpectrum offer a number of easy and comprehensive ways for you to streamline the accounts receivable process (there is help!), we also want to take a moment to inform you of some of the common ways practices lose money, and to laugh at the hilarity and sometimes sad instances when claims get denied or patients won’t pay their remaining responsibility.

And so we present to you the top 3 silliest and needless ways to lose money in the A/R process:

  • Following up with patients on their owed amount following insurance collection, and even alerting credit agencies to past-due balances is about as fun as a cross fit class. It’s just plain exhausting. With patient deductibles increasingly susceptible to larger deductible amounts with certain aspects of the Affordable Care Act (ACA), it’s no surprise that many patients get sticker shock when they receive a bill. Pair this with a lack of patient education on their responsibility before services are rendered and you’re likely to end up with a lot of “I’m not paying this.” Some people even get so emphatic that they write entire blog entries on how they simply won’t comply with Obamacare. Yikes.

Don’t lose money in the patient responsibility collection piece of accounts receivable. Educate your patients about their responsibilities before they receive a bill they might not be able to afford in full at the time. ClinicSpectrum’s Eligibility Verification can help in this area.

  • We have heard terrible stories from our customers prior to our engagement, of the slightest minutia of information being listed incorrectly on a claim. These small errors, often credited to a busy office and innocent human error, can cost your practice time and money. We’ve even heard claims going unsettled for nearly one year because of a spelling error, misdiagnosis or number listed incorrectly.

To the rescue! ClinicSpectrum also has knowledgeable staff, products and solutions to make sure headaches like this don’t happen.

  • You call, call, and call – and call one more time – but the insurance company is just plain UNAVAILABLE to help you on a claim. We can bet you have one thousand better things to do during your busy day than to remain ear attached to the phone hitting redial or trying to navigate complicated automated phone system menus.

ClinicSpectrum can easily save you from all of this hassle. We have a proven insurance claims follow-up process divided into three methods:

  1. Online Claims Follow-Up – Using various Insurance company websites and internet payer portals, we check on the status of outstanding claims.
  2.  Automated Claims Follow-Up (IVR) – By calling Insurance companies directly, an Interactive Voice response system will give the status of unpaid claims.
  3.  Insurance Company Representative – If necessary, calling a “live” Insurance company representative will give us a more detailed reason for claim denials when such information is not available from either websites or Automated phone systems.

Is that a collective sigh of relief we hear?

Don’t lose money when it comes to collecting money owed to your practice. Contact us for an assessment. We want to help you get money in the door.

Outsourcing Selected Back-Office Tasks at Physician Practices

Each step within the revenue cycle management (RCM) process at physician practices builds on previous tasks, so mistakes made Credentialing Servicesearly in the process can end up snowballing into larger problems.

The task of verifying patient eligibility is a perfect example. If done improperly – or not done at all – claims can later get denied and the practice is forced to forego the revenue generated by that encounter.

Although vital to any physician practice, back-office functions are often tedious, time consuming and costly. To reduce the burden of these tasks, practices can choose to outsource specific RCM components to help streamline operations. Two specific functions that are ideal for outsourcing include patient eligibility verification and payment posting to help with the following:

1) Applying correct payment to patient responsibility as deductibles have become a big issue.

2) Applying correct payment to secondary responsibilities.

3) Creating a follow up work queue for denied or partial paid claims when compared with Insurance Fee schedule.

Eligibility checking is the single most effective way to prevent insurance claim denials. Outsourcing this service is simple. The service provider retrieves a list of scheduled patient appointments and verifies coverage using one of three methods:

  • Online, using insurance company websites and payer portals
  • Calling the interactive voice response (IVR) systems at insurance companies and working through menus to determine eligibility status
  • Calling insurance company representatives directly when online or IVR options are not available, or to resolve more complicated situations

Outsourcing payment posting and reconciling is also a simple process, and enables providers to determine if full reimbursement was received. Outsourced service providers accomplish this via two ways:

  • Manual posting – Paper explanation of benefit (EOB) statements received by physicians are collected and sent to the billing service by one of two methods. They can scan documents and send them to the service electronically, or they can simply send the paper documents to the service. Payment posting is performed in batches to ensure proper accounting and to reconcile bank deposits with EOB statements
  • Auto posting – When EOB payments come in the form of electronic remittance advice (ERA), these files can be downloaded directly into the physician’s practice management system. All posting is done directly in the system, so providers can audit at any time.

Outsourcing selected components of the RCM process is an easy way for practices to streamline operations, decrease denials and ensure payment accuracy. More importantly, it’s a great way to get tasks completed correctly the first time, rather than having to endure the headaches of correcting them later in the RCM process.

The Eligibility Verification Time Suck

This post was originally appeared on EMR AND HIPAA.

Eligibility verification has always been a challenging part of running a healthcare business. However, that challenge has become even Vishal-Gandhimore difficult as the Affordable Care Act has caused a wave of newly insured patients along with patients who are switching insurance carriers flooding into physician offices. Verifying and learning the details of the patients’ new insurance policies has created a lot of new work for a clinic’s staff.

In the perfect world, there would be an automatic verification system that would easily look up a patient’s insurance policy and the details of their plan. While some companies are trying to make automatic insurance verification a reality, it’s currently very weak and still requires a lot of human intervention and interpretation. Maybe one day the payers will fix that, but until then it’s important that a practice creates a smooth process for verifying a patient’s insurance. In many cases this includes hours browsing insurance company websites and internet payer portals or waiting on hold for hours a day on automated voice systems or insurance company call trees. Is that the best use of your staff’s time?

I don’t think I need to describe in detail why having the insurance eligibility and plan details as early as possible is important. If you don’t have this information, your ability to get paid by the patient for the services rendered goes down and your claims denials go up. Plus, many of these new insurance policies are high deductible plans where you’ll need to collect a lot more money than usual from the patient. One way to solve this problem is to know how much the patient owes before or at least while they are in the office. The best opportunity to collect from a patient is when they are standing in front of you.

While internal staff can do a great job verifying insurance eligibility and obtaining benefits summaries, this can be a challenging job while handling all of the other front desk or billing duties as well. One solution to this problem is to outsource the eligibility verification task. A list of scheduled appointments is supplied to the outside company and after verifying insurance coverage for the patients they put the coverage details directly into your appointment scheduler. Obviously the key business question here is to compare the cost, timing, and quality of an outside service against the cost, timing and quality of your current staff doing it.

One related challenge that many practices are facing with all of these new and changing insurance policies is the time staff spend educating the patients. Most patients did not spend time really understanding the insurance policy they were buying. They looked at the price and largely bought without reading the fine print. This often means your staff are tasked with sharing the details of the policy and dealing with any fallout. In some ways, this isn’t a new task. However, the volume has increased.

Another solution offices should consider is doing the eligibility verification well before their appointment. Then, using a secure messaging solution the practice can share a patients’ eligibility and plan details including any co-pays and deductibles with the patient before they even arrive at the office. This early communication gives the patient time to call their insurance provider instead of your practice for all the details. Plus, it makes the patient payment expectation clear before the patient even enters your office.

How much time is your office spending verifying insurance? What solutions are you using to improve your eligibility checking and communication workflow?

The Cost Effective Healthcare Workflow Series of blog posts is sponsored by ClinicSpectrum, a leading provider of workflow automation solutions for healthcare. Their Eligibility verification service is a great way to leverage technology and people to solve the eligibility verification problem. ClinicSpectrum also offers a secure messaging product called MessageSpectrum.

Quit ‘Leaving Money on the Table’ with Automated Collection Software

At what point should practices “leave money on the table” and abandon their collection efforts on patient-owed balances? It’s a difficult decision that today’s practices are being forced to make more often than they’d like.

Automated Collection SoftwareCollecting past-due balances from patients is an important component of the revenue cycle that physician practices must actively manage, but it’s costly, time-consuming and labor-intensive. Only a relatively small percentage of efforts result in successful collection. For the remaining patients who fail to respond, practices are forced to report debts to credit bureaus or take legal action to collect past-due balances. In the end, every dollar invested in the collection process is one less dollar of profit for the practice.

But it gets worse. The cost of collecting on small-dollar accounts can easily exceed the past-due balance. The result is that many practices choose to “leave money on the table” rather than pursue advanced collection efforts. Over the course of year, these ignored accounts add up to a substantial sum of money.

Perhaps now, with the assistance of technology, practices will no longer have to make the decision to forego collecting past-due balances. A new breed of automated collection software eases the burden of patient collections. These solutions reduce the time and costs associated with standard mail delivery and costly representative phone calls.

Automated collection software can be installed and managed by practices to relentlessly – within regulations – contact debtors to increase collection rates. Practices that are considering the implementation of this software should look for the following capabilities:

  • Messaging Options – These allow practices to tailor how the patient will be contacted. Options include text, secure text, email, secure email, push notifications to smart phones, and automated calls. These options allow practice to contact debtors via multiple methods to increase collections.
  • Decision Rules – These allow practices to configure when and how often the debtor is contacted. Options include setting the date, time, hour and frequency of contact.

Practices employing automated collection software can reduce their collection costs and increase the chances of collecting balances by eliminating representative involvement and automating the process. Most importantly, practices can quit “leaving money on the table.”