By Jessica Woodall
We’ve worked with hundreds of offices to help streamline the claim filing process by uncovering unknown hurdles and inconsistent habits. Throughout this work, we’ve identified 11 of the most common problems we’ve seen across the board when it comes to benefit administration, claim filing, and accounts receivable management. Today we want to share common problems and some important questions to ask yourself to help find solutions to these challenges for a more profitable cash flow.
Benefit Administration:
1. Eligibility and benefits aren’t being pulled prior to the appointment: Is there a team member(s) responsible for verifying eligibility and benefits? Do you have a SOP? Does the team member have the proper tools to verify both medical and vision?
2. Miscalculating out of pocket responsibility: Is the optical staff trained on how to properly calculate patient responsibility for material?
3. Misunderstanding of what’s included in a patient’s benefits: Are you educating your staff on how to read the benefits and know the tiers of lenses and lens options? Do you have a quick reference guide created for all your vision plans?
4. Not participating in all of the available plans under the MVC for your region: When was the last time you updated your plan participation?
Claim Filing and Account Receivable Management:
1. Not utilizing a clearinghouse or integrated Practice Management System for managed vision care claim filing when available: Do you know the capabilities of your PMS and clearinghouse?
2. No checks and balances to ensure all vision plan claims are entered into the portal within 24 hours: Is there a process for not only balancing the day’s money but also ensuring that all claims were submitted.
3. Lack of knowledge for reducing chargebacks and lab fees: When was the last time you analyzed your cost of goods using the vision plans lab? Do you know the cost benefit to opt out of the vision plans lab if allowed? Do you spot check payment posting, is your staff line item posting or single entry?
4. Lack of line item posting and timely posting to ensure accurate accounting: Do you spot check payment posting? Is your staff line item posting or single entry? What lens options are NOT being put into the PMS or collected from the patient but are on the lab order? IE edge polish, might be on the claim with $15 patient copay, but it is not in the PMS and the patient wasn’t charged. When the remittance is available and the money is in the bank, what is your requirement of when that remittance is reconciled in the patient’s account? Is it within a week of the remittance date?
5. Inconsistent review and management of the aging report: Do you have a protocol and who is responsible for keeping MVC aging under 60 days? If yes, you should have no outstanding MVC claims older than 60 days. What does yours look like? If you don’t have up to date account reconciliation then you truly have no idea of what is outstanding. If you don’t have a protocol for item 4 then item 5 will be a time consuming project.
6. Missed opportunities for billing all that the plan allows: For example, some plans allow you to submit a dispensing fee code for reimbursement, that typically results in $15-30 cash back in your pocket. Or that edge polish!
7. Unorganized record keeping/not keeping the necessary documents: Who is responsible for ensuring all the necessary documents are in the patient’s record? It may vary across roles – poster could scan in EOB, front desk the insurance/MVC cards, optician lab invoice, etc. If you don’t have the necessary information readily available, valuable time can be lost when you need it later.
If you recognize any of these issues and need assistance with conducting an audit or ensuring your practice is properly set up for successful claim filing, we’re here to help. Contact us for a free consultation to help discuss your challenges.