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

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.