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 vishal@clinicspectrum.com.

Quit Leaving Money On Table!

Needless Ways Your Practice Is Losing Money

Did 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 early 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.

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.

Collecting 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.”

Credentialing Dashboards Keep Staffs on Task, Better Communicate Status

Dashboards. To some, the concept is met with open minds and eagerness to view the data in a snapshot. To others, the term conjures up a notion of marketing spin. Can anything really be that great? The answer is yes. If done well, dashboards can not only brilliantly communicate key data to your staff, but keep everyone on task and efficient.

When looking at physician credentialing, communications are a vital part of the process, as everyone needs to know the status of tasks—what’s in progress and what remains to be completed. This information needs to be shared among various stakeholders, such as the credentialing staff, providers, practice administrators, and others. For credentialing, communicating this information is vital to practice operations, reducing risk, and ensuring that providers are eligible to receive reimbursement for their work.

Using a credentialing software solution with a dashboard display is an ideal way to share this information in a format that is easily digestible so information becomes actionable. Dashboards are a graphic representation displaying an up-to-date snapshot of tasks, whether they’re newly assigned, in progress, on hold, or past due. A credentialing system dashboard should be easily accessed, and provide an overview snapshot, milestones, drill-down capabilities, and the ability to view tasks and processes from different perspectives. Here’s a look at the first two of these.

Easily Accessed — When users open the credentialing system, the first thing they should see is the dashboard display. This quickly communicates the status of tasks, and alerts them to issues that need resolving. The easy accessibility of the dashboard eliminates the need for users to click through menus to view the information. It also decreases the chances that important information will get ignored, overlooked or simply not communicated.

Overview Snapshot — The dashboard should display a broad overview of the process that users can click on to get more detail, also known as “drill-down” capabilities, which are explained below. This overview enables the dashboard to display information of value to multiple user types, whether they are providers, practice administrators, or the credentialing staff. The dashboard should display:

• Status of providers being credentialed (e.g., new, in process, on hold, completed, or custom credentialing)
• Counts of providers with insurance
• Status of the credentialing process by task
• Credentialing task aging (e.g., 0-30 days, etc.)

Start by looking for these items in your dashboard, and watch your credentialing process go more smoothly.

 

*Photo is under Creative Commons License.

Automating Balance Collection Using Technology Platform

Automate to Collect patient balances

Out of sight, out of mind. Applied to healthcare, this age-old saying is not only true, but also incredibly problematic for physician practices. All too frequently we hear from physicians the same story of providing care up-front, and subsequently facing a growing stack of un-paid deductibles, ultimately hurting the bottom line. No one is immune to this – not general practitioners, specialists, psychologists, nor dentists.

With the trend of increasing deductibles, there is only going to be more to collect. For 2014, the internal revenue service has defined high-deductible as $1250 for an individual and $2500 for a family. On top of that, maximum out-of-pocket expenditures are estimated at $6350 for individuals and $12,700 for families. That’s no small change; that’s real money when factoring in the number of patients you see.

Some practices may have an initial reaction of fear or a sense of alarm from these numbers however, these statistics should be the impetus to be proactive and put the right series of steps and technologies into place. Those steps include implementing a hybrid workflow model that starts with using an established eligibility checking system to identify a patient’s expected out-of-pocket costs prior to an appointment will significantly lessen the follow-up collections that are needed. However, when you do need to collect, make sure you are doing it smartly by leveraging the second piece of a hybrid workflow solution, an automated collection system to significantly increase the odds that you will collect more, and also collect it faster.

Recent highlights from the Pew Research Internet Project state that as of January 2014, 58% of adult Americans have a smartphone.  Doesn’t it make sense then that you should have an automated system that includes texting alerts instead of sending outdated hard copy letters? By replacing traditional collection methods with an automated technology platform that smartly uses decision rules to push out text and secure e-mail, and logs a record of all the activity, you can count your profits instead of counting the number of uncollected deductibles.

Automate to Collect

Out of sight, out of mind. Applied to healthcare, this age-old saying is not only true, but also incredibly problematic for physician practices. All too frequently we hear from physicians the same story of providing care up-front, and subsequently facing a growing stack of un-paid deductibles, ultimately hurting the bottom line. No one is immune to this – not general practitioners, specialists, psychologists, nor dentists.

With the trend of increasing deductibles, there is only going to be more to collect. For 2014, the internal revenue service has defined high-deductible as $1250 for an individual and $2500 for a family. On top of that, maximum out-of-pocket expenditures are estimated at $6350 for individuals and $12,700 for families. That’s no small change; that’s real money when factoring in the number of patients you see.

Some practices may have an initial reaction of fear or a sense of alarm from these numbers however, these statistics should be the impetus to be proactive and put the right series of steps and technologies into place. Those steps include implementing a hybrid workflow model that starts with using an established eligibility checking system to identify a patient’s expected out-of-pocket costs prior to an appointment will significantly lessen the follow-up collections that are needed. However, when you do need to collect, make sure you are doing it smartly by leveraging the second piece of a hybrid workflow solution, an automated collection system to significantly increase the odds that you will collect more, and also collect it faster.

Recent highlights from the Pew Research Internet Project state that as of January 2014, 58% of adult Americans have a smartphone.  Doesn’t it make sense then that you should have an automated system that includes texting alerts instead of sending outdated hard copy letters? By replacing traditional collection methods with an automated technology platform that smartly uses decision rules to push out text and secure e-mail, and logs a record of all the activity, you can count your profits instead of counting the number of uncollected deductibles.

Automated Billing: Increase Time with Patients, Practice Profitability

Physician practices are very aware of the growing amount of deductible collection that will be necessary with the huge influx of eligible patients under the Affordable Care Act. But while they are very aware, this doesn’t necessarily mean they have measures set up to best prepare for this influx. If they have set preparatory measures, are those measures helping to simplify processes and work flow, or is there now just more work to be done?

All of the physicians I work with go into practice to help and heal people. They didn’t study medicine to then explore the ins and outs of all things payer, billing, and appointment reminders. For those with smaller practices, they and maybe one other clinical staff member are multitasking; handling everything from diagnosis to accounts receivable follow-up, and even eligibility verification. Add back- and front-office operations to that and you’ve got a formula for loss in revenue and harried business operations. Some of the most prevalent and common issues I see physicians’ practices face include:

•  Increased cost in overall operations
• Reimbursements and revenues decreasing
• High deductibles or increased patient deductibles
• Delays in collection of deductibles and other balances due to billing inaccuracies
• Employee compensation increases
• Overall inflation of business operation costs
• Confusion about healthcare reform specifications for small- to mid-sized practices
• Failure or lag in communications through traditional phone calls and mailed letters

But there is a better way: Automating billing and collection systems that will maximize profitability and increase time with patients. While undoubtedly there will be skepticism from some physicians after a decade of the failed promises of enhanced productivity and improved care from many EHRs and other systems, automated billing can be done, and at a cost that won’t elicit sticker shock. You can:

• Streamline collection methods. This can often be a bane for back-office operations to say the least. Manual collections often result in massive amounts of paper records, hard copy mailings, and staff hours following up with patients on balances owed. Your office staff should be welcoming patients and becoming more involved in their care to help keep them with the practice; not manually dialing phone number after phone number so you can get dollars in the door. Additionally, just because you have the staff to do the office work, doesn’t necessarily mean that work is done cost-effectively and successfully.

• Increase/better target use of communication such as secure text, e-mail, and phone calls. Similar to my above point, free up your back-office operations to do the most important things for your practice. By targeting communication channels specific to your patients’ likes and needs, you streamline your practice operations. You aren’t hard-copy mailing a young patient who only responds to text messages. You aren’t e-mailing a patient who checks e-mail once every month.

• Report non-responsive debtors to credit bureaus and/or legal departments to take the workload off of the practice staff. By automating processes, your staff isn’t bogged down by work when people don’t pay. There are solutions to freeing up their time and making sure your practice profits.

Here’s an example that might apply to your practice: Take a look at your eligibility verification. If each claim denial costs your practice $25 to $30, and you know your denial rate is above the industry average of 3 percent, the monthly cost for eligibility verification in advance of patient visits shows an outsourcing company with this specialty effectively pays for itself. As a patient, and with friends and family who are patients, I want to know that when I see the doctor that he is able to be clear minded and exclusively focused on my care or the care of my family member. With automated billing solutions in place, physicians can focus on the practice of medicine, freeing their time to focus on patient care, and work with their office staff to maximize profitability. Vishal Gandhi is chief executive officer of ClinicSpectrum, leaders in hybrid work flow solutions consisting of both an innovative software suite and back-office operations. E-mail him here. See more at: http://www.physicianspractice.com/blog/automated-billing-increase-time-patients-practice-profitability#sthash.rsbGuhJD.dpuf