By Christi Arnett, MBA, CPC
Take steps to remove barriers that prevent timely claims payment.
A new billing manager has been hired by a physician’s office with implicit instructions to “clean up” the current mess. Reviews of the current accounts receivable (AR) and denial management reports reveal many outstanding claims for incorrect payer, invalid ID number, and “patient cannot be identified as our insured.” What should this manager do to ensure success?
For the revenue cycle management (RCM) department of a physician practice, success is measured in dollars and cents. To improve cash flow, this manager will need to find the roadblocks that are hindering insurance payments.
Start at the Front
The first step this billing manager should take is to evaluate the front desk, checkout desk, and billing teams’ operations. The revenue cycle begins when a patient enters the practice, making the front desk one of the biggest potential barriers to revenue.
The front desk staff needs to be concise, detail-oriented, and able to multitask efficiently. Incorrect ID numbers, spelling errors, and insurance verification issues create errors before a claim is even submitted.
If these types of errors are occurring, find out if staff members are taking time to review the information input into the practice management system. Human errors are going to occur, but we can minimize them when we take the time to review the information we are inputting.
Train Staff
Submitting claims to the wrong insurance payer is a barrier that can easily be avoided by carefully reviewing the insurance card and verifying the payer ID. If this isn’t happening, perhaps your staff hasn’t been properly trained. Practices commonly place new hires at the front desk to learn the software. Proper insurance training should be given to all staff members who may have to check a patient into the system, including anyone who fills in for the regular front desk personnel.
Training should ensure front desk personnel:
- Understand the insurance verification process;
- Know the proper questions to ask the patient to obtain the correct insurance information; and
- Know how to scan the insurance card(s) into the patient chart.
There is much more you can include in your training, but these tasks pose the biggest barriers to payment if done incorrectly, or not at all.
Check In at Checkout
Barriers at checkout can include:
- Invoices not being reviewed before claim submission;
- Copays and/or deductibles not being collected at the time of service; and
- Medical records not being signed by the provider.
When barriers exist, the billing team will not be able to submit claims promptly.
Set Up for Success
Roadblocks can be easily identified with a thorough review of billing processes from check-in to claims submission. Once issues with the billing team are resolved, our new billing manager can put processes and guidelines in place that will prevent new roadblocks and ensure future success.