Improve Your Medical Practice Billing Process in a Few Simple Steps

By P.j. Cloud-moulds from Physicians Practice

My old primary-care physician was a really great physician.  She spent enough time with me, asked great questions, was always available, and took very good care of me.

So then why is she no longer my physician after fifteen years? Because of the back-office billing staff. They were rude, unorganized, didn't know how to post payments for the life of them, and continuously billed me in error. This is a very, very common problem in most physician practices.  Have you read your Yelp or Healthgrades reviews?  They may say something like: “My doctor's care was great, but the billing office experience was awful.”  If this is the case in your practice, fear not. I have cracked the code on customer service in the billing department. At my practice, I started testing this new process after an outstanding brainstorming session with my staff.  They were very eager to change the flawed billing process, and we fumbled through a few revisions before we finally got it right. Here's what we do:

•  Once we close the month for processing, statements are run.
• Immediately, we review each and every statement.  It took us about three months to clean up the riff raff that was plaguing accounts receivable
• During the statement review,  we consider four important questions:
1.  Did our system post the monies properly, and is this a true patient balance?
2. Has this patient been on the A/R list for more than 90 days? If yes, we send them a pre-collections letter.  If they then don't pay within 15 days, we send them to collections.
3. If the patient is showing a balance, is it because it was not processed by the insurance per the original verification?
4.  If the patient is showing a balance, is it because it was not collected up front or posted properly in the system?  We also identify the exact date of service a payment is missing.
• Once we have reviewed all of the statements and we have identified true statement balances, we check in with the front-office staff to see if they have receipts for those specific dates of service.  If they have receipts, we post them and remove the statement from the list going out. 
• We document this information in an easy to access spreadsheet-type format so that when patients call in, we have already identified the problem and can quickly, and efficiently answer their question with full confidence.

By spending about four hours of time up front, we ended up saving three full-time staff the better part of an entire week that would have bent spent dealing with billing headaches.  That's pretty good ROI. 
Make strides towards providing a good billing experience for your patients.  We have and it has made all of the difference in the world.  Remember, “That's just the way it is” is a crutch and an excuse for not being brave enough to change what needs changing.

Article from physicians Practice:  http://www.physicianspractice.com/blog/improve-your-medical-practice-billing-process-few-simple-steps?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=04032014

Keeping Up with the Copay: Health Plan Changes Always Happen

By Melissa Young, MD from Physicians Practice

I’ll be the first to admit: I don’t know all the details of my own medical insurance plan. And I’m the one who chose it! I reviewed the benefits at the time. I looked at what the copays would be for office visits and meds, and I looked at what the out-of-network benefits would be. Thankfully, I have not really needed to use it much, so I have forgotten much of the details.

Many of my patients are no better. I doesn’t help that their employers change their plans from year to year. And even if they keep the same plan, the insurance companies change their formularies and their benefits all the time. It often comes as a complete surprise to patients.

For example, I have one patient for whom I prescribed a medication earlier this year. The cost to her at the time was minimal; her prescription plan paid for most of it. She is due for it again now, but now she has this big deductible and it is going to cost her hundreds of dollars. I also have a patient whose ultrasounds I used to do in the office …until her plan decided they didn’t cover it if it was done here, so now she has to get it done in radiology. Of course, neither of us knew that before the last ultrasound I did here. Drugs that didn’t need prior authorization six months ago need it now.

I am certain patients are informed one way or the other about changes in their copay (although many of them seem surprised when my staff asks them for $40 instead of $25 like they paid last time), and maybe they get notice about other changes, but I would not be surprised if they give any mail they get from their insurance company a quick glance and then toss it. I can’t say I blame them. We all get so much mail that looks like junk; it can be hard to figure out which ones are really important. And since things change from month to month, who can keep track of it all?

Courtesy of Physicians Practice: http://www.physicianspractice.com/blog/keeping-copay-health-plan-changes-always-happen?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=22112013

Health Insurance Exchanges: Two Key Issues to Discuss with Patients

The American Academy of Family Physicians (AAFP) is encouraging its members to provide their patients with information regarding health insurance exchanges.

The AAFP website advises: "During patient visits, be prepared to discuss the insurance options available through the marketplaces and encourage patients to make coverage decisions that are appropriate for their health care needs. "But not all doctors are ready to get involved.

The majority of physician respondents to a recent Medscape survey said that they should either have a limited role or no role in providing health insurance and health insurance exchange information to patients.

Yet, spending a few minutes sharing some key information about health insurance exchanges with interested patients may benefit you and your practice in the long run.

Here's why: If your patients that are shopping on the health insurance exchanges don't make well-informed purchasing decisions, you may see them less frequently. In fact, you may not see them at all.

Many of the health plans offered in the exchanges appear to have narrower networks — meaning patients will likely have fewer physicians and health systems to choose from within the plans.

In addition, many of the health plans offered in the exchanges have higher deductibles — meaning patients may end up shouldering more of their healthcare costs.

"They are trying to funnel people into narrow networks overall, and simultaneously shift people into higher cost sharing that is higher deductible, higher copay kind of plans," Kip Piper, a healthcare consultant in Washington, D.C., recently told Physicians Practice.

If patients purchase those higher cost sharing plans, it's likely that they will put off or avoid visiting your practice due to cost concerns, said Piper. In addition, higher patient cost sharing will place more burdens on your collections staff, as they will need to step up patient payment collection efforts. 
For that reason, you might want to consider talking to your patients about the importance of finding a plan that does not require a lot of out of pocket costs. "Make sure that ... they're not enticed by a low premium to pick a plan that has a high cost sharing that then keeps them out of the doctor's office," said Piper.

The narrower networks offered by many of the plans may also pose problems for your practice.

If you are excluded from a plan or if you have decided to opt-out of a plan, you run the risk of losing your patients to providers who are participating in that plan. For that reason, you might want to share which plans you are participating in with patients.

"I'm afraid of a lot of people in January are going to start making an appointment and then they're going to find out they can't go to their doctor," said Piper.

Article By Aubrey Westgate from Physicians Practice http://www.physicianspractice.com/blog/health-insurance-exchanges-two-key-issues-discuss-patients?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=03122013

How Late Payments, Patients can Throw off a Medical Biller's Day

By Marsha Sosebee from Physicians Practice

Dear Diary, even though it’s Monday, today started out with much promise of being a good day. The end of month collection percentage totals for last month looked great. The percentage of money in the over-120-day-and-aging bucket was down to 0.2 percent and the overall amount due on the accounts receivable report was down by $32,000. I had high hopes that the day would end as well as it began.

My first task of the day was to review the schedule to see which of today’s patients had a past due balance. Finding four such patients, I began to review their history and send necessary alerts to the receptionist. The first two patients had balances from surgeries and were making regular monthly payments as promised. So far so good. The third patient had owed a balance for almost two months and had not yet set up a payment plan, even though he had been back for a recheck appointment just last week. That’s where my hopes for the day began to sag a bit.

The fourth patient had been the victim of a car accident and one of our doctors had been called from the emergency room to do surgery. The hospital had not given us any insurance information on this patient, so I looked to see what information the patient had given at his first recheck appointment in our office. Nothing was written in the section for insurance. Great. As I read through the note history, I found a note from the receptionist that said, "At checkout, asked patient to pay on surgery balance. Patient responded that the accident was the other guy’s fault and that’s who would have to pay the bill." Further notes revealed his adamancy that he was not going to pay this surgery balance. We were at an impasse because our doctor was on main ER call that day and we were required to continue seeing him until treatment was complete. At this point, my hopes for the day were swinging mighty low.

I called the car insurance claims adjustor only to be told that the hospital bills had exhausted the MedPay limits on the patient’s automobile policy and the at-fault driver did not have car insurance. The patient’s attorney had already been in contact with them about a settlement but in all reality, it would probably end up going to court. The adjustor said that if a settlement was reached, it would be paid to the patient who would be responsible for using it to pay the remainder of his medical bills.

I added my note to the history and inserted a pop-up note that I needed to speak with the patient when he arrived. Judging by the previous encounter our staff had with him, I was not looking forward to his arrival at 10:30.

The next order of business on the “to do list” was to check status of pre-certs that had been requested last week. I called ABC insurance company first because three of the precertifications were theirs. I don’t know how so much changes in one week at insurance company, but apparently it can. I dialed the same number I had called the week prior to begin the precert process. After going through the maze of prompts, a person answered who informed me that I had reached the wrong department. I assured her I had chosen all prompts carefully. She asked for the number I had dialed originally. I told her 800-000-0000. She said that was the problem; that number was not for precerts at all. She agreed to transfer me to the correct department. The person in that department would have loved to help me, but they don’t handle precerts for that employer group. Again, I was transferred to the correct department. Four transfers later, I finally connected with a representative who said that if I had just dialed 800-000-0000 I would have reached her directly and avoided all of this unnecessary frustration. I’m glad she couldn’t see my expression through the phone.

Confident that I had at last reached the right person, I gave her the patients' information for whom I had requested precertifications. Two were in process she said, but the third request was not on file.

"Why not?" I demanded to know. I had sent all three sets of clinical information and photographs in the same envelope. If two were there, what happened to the third one, I wanted to know. The rep suggested that maybe I had forgotten to include the third one. I knew I had put all three in there. After 20 minutes of back and forth and being put on hold so she could check with other departments, she finally came back to the line to let me know it was found in the mail room. She informed me that I would have to send the photographs again because she was not able to locate them.

At this point, I gave up all hope for the day ending on a good note and I was pretty sure this was a good indication of how my week was going to be. It was also at this point that I wondered if other billers really faced the same frustrations as me. I also contemplated whether or not billers should automatically have a prescription of Prozac. Like some people have a jar of peppermints on their desk, maybe billers need a little jar of happy pills.

Signed,

A frustrated biller

Article courtesy of Physicians Practice http://www.physicianspractice.com/blog/How-Late-Payments-Patients-Throw-off-Medical-Billers-Day?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=07112013

Improve Patient Education to Improve Medical Practice Collections

Often patients misinterpret how, and how much, they will be billed for their visits.

Take for example, the copay. When patients pay a copay at time of service, they sometimes believe this is all they will owe. So when they receive a bill in the mail a few weeks later, they complain.  They call and say something like, "I was told I only had a $10 copay, and that's ALL I am paying!”
Addressing a patient concern like this one takes up staff time and hinders the collection process. Staff may feel so bad when speaking with a patient that they may even adjust off the patient's balance.

Problems due to payment misinterpretations, however, are avoidable if your front-office staff spends a few minutes prior to a patient's appointment explaining how the billing process works. 
A front-office person should come out to the lobby, sit with the patient, and explain each policy the patient will need to sign, including your practice's privacy policy, payment policy, and cancellation policy. This will indicate to the patient that he is valued and cared for.

Explaining the payment policy and how benefits work in a calm and professional manner will provide the patient with a much greater understanding of how his policy works. Over the years I have seen firsthand how many patients have a poor understanding of these important elements.   Although this one-on-one patient explanation might seem like a concierge-type service, it's a sound investment to make in your practice. 
Patients will no longer misunderstand how payment works, and they will have a greater understanding of insurance. That of course, will translate to more streamlined patient collections.

Patients will also have a better understanding of their benefits, which means they will  understand when billing questions and complaints should be directed to insurers, rather than to your practice. With all of the insurance exchanges marketing to patients; and the print, electronic, and television ads touting “affordable plans” to your patient population, it is more imperative than ever to spend the time explaining patient benefits clearly.
Consider the time spent explaining payment and benefits to your patients as part of your customer service package. Train your front-office staff to step out from behind the desk, sit with the patient, answer any question, and build rapport. You won't be sorry.

Article  By P.j. Cloud-moulds of Physicians Practice
http://www.physicianspractice.com/blog/improve-patient-education-improve-medical-practice-collections?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=01112013

Boost Medical Practice Collections by Cutting Down Patient Statements

By P.j. Cloud-moulds from Physicians Practice

Do you know how many patient statements are sent out at your practice? Do you know how high that A/R class is? These are two very important questions you need to ask yourself today. The numbers might shock you.

If you do find that the number of patient statements is too high, you can then start asking why this is the case. Here are some of the common reasons:

Your front office staff did not collect the patient copay, coinsurance, or deductible. If you have an up-to-date fee schedule, calculating the patient coinsurance and deductible is easy, and should be done at the end of the appointment prior to the patient walking out the door. Copays are easy to collect and should be collected at the beginning of the appointment.

Your front-office staff did not collect according to plan details. When verifying an insurance plan, sometimes the insurance company will provide incorrect information. Your staff may also be calculating the patient portion incorrectly. Be sure your staff is well trained in this area. It's costing you a lot of money if they are not.


 Patients are paying at the time of service, but those payments are not getting posted properly. This results in a nasty call from the patient stating that, “I paid, and will not pay again!” This is the epitome of poor customer service. Institute checks and balances at the end of each day to ensure payments are posted.

Patient “forgot their checkbook or credit card.” This is a line that you hear too often, and it's full of hot air. If the patient “forgets,” let him know that he can call in his payment by the end of the day, or he will incur a late payment fee. Yes, this is legal. If the patient can't pay now, he certainly won't pay in a month when he gets the bill.

Staff adjusts off a patient deductible. Your front-office staff performs the insurance verification, and sees that the patient has a $5,000 deductible of which only $352 has been met. Once the deductible is met, the patient is responsible for 20 percent of the allowed charges. Your front-office staff is reluctant to charge the patient the deductible amount for fear of being yelled at by the patient (who should already know her plan limitations, but most often does not) so staff charges her the co-insurance instead. This results in the patient getting a bill for the remaining amount. The angry patient then calls and yells at the staff stating, “I paid at the time of service!” Another example of poor customer service. Remember, you cannot adjust off a patient deductible.

The patient has Medicare and a secondary insurance. Since we are not allowed to collect monies from Medicare patients until Medicare pays its portion, we bill the secondary. If the secondary does not pick up all of Medicare's 20 percent, then the patient gets a bill. It's really difficult when some Medicare patients do not understand their secondary insurance has a deductible, or will not cover the entire 20 percent.

Just sending out statement after statement is a very poor way of running a business. Have a time limit of how many statements you will allow a patient to receive. Three months is a good rule of thumb. If patients need to be put on a payment plan, that's great, but put a time limit on that, as well. Your practice is not a bank, credit union, or credit card. It is a business, and no other business would allow goods and services to walk out the door before payment. Stop allowing patients to take advantage of your good nature.

Article taken from Physicians Practice http://www.physicianspractice.com/blog/boost-medical-practice-collections-cutting-down-patient-statements?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=22102013

How Practices Should Deal With Late Patients

By Marisa Torrieri from Physicians Practice

Even if practices have clear-cut policies on handling no-show patients, dealing with late patients — especially those who are chronically late to appointments — is another issue altogether.

Late patients can throw off a practice's schedule and affect the amount of time physicians can spend with patients, especially in a small practice. Therefore, dealing with them raises questions: Should you accommodate late patients right away? Can you show them the door?

Declining to see a patient isn't usually an option, as it can be downright unethical and could actually cause a legal problem.

"Turning patients away if they're arriving late — you must talk to your malpractice carrier about that," says Elizabeth Woodcock, an Atlanta-based healthcare consultant, trainer, and author of "Mastering Patient Flow to Improve Efficiency and Earnings." "And you need to understand any malpractice risks you're taking by implementing such a policy. Unfortunately, if they have a heart attack on your doorstep as they're walking away, it's going to be your problem."

It's important to try and get the patient in to see someone if possible, such as a nurse or another doctor, says Ericka L. Adler, a partner at the firm of Kamensky Rubinstein Hochman & Delott, LLP, and contributor to Practice Notes, PhysiciansPractice.com's blog. If a patient does not get required care that can come back to hurt the physician if something happens to the patient, she adds.
Practices do have some options, however.

The first thing a practice can do to diminish late patients is make sure it is generally running on time.

"Please, please make sure that your practice is running on time," says Woodcock. "The practices that yell the loudest about chronically late arrivers are the ones who run late themselves. If the doctor is always running an hour behind, I'm going to run an hour behind [as a patient]."


Only the doctor or another healthcare provider can determine how important it is to see a given patient quickly.

Woodcock suggests that if a patient is more than 20 minutes late, front-desk staff should contact the clinical team and see how soon a patient should be seen.

But for future appointments, chronic lateness may qualify as a valid reason to dismiss a patient entirely if they don't change their behavior.

At Performance Pediatrics in Plymouth, Mass., late patients — those who are more than five minutes late — are treated the same as no-show patients. On the first and second offenses, they're sent a warning letter. On the third offense, they're told they will be dismissed if the problem continues. And on the fourth offense, they are asked to find another provider.

"If you're five minutes late, everyone is five minutes late," says administrator Leann DiDomenico McAllister, adding that sometimes traffic can be bad on a particular day. "But we're talking about people who are a half-hour late. Or people who call an hour before their appointment because they forgot their kid had a baseball game."

Article By Marisa Torrieri from Physicians Practice
http://www.physicianspractice.com/blog/how-practices-should-deal-late-patients?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=15102013

Medical Billing Disputes: Finding Peace between Patients and Billers : Don't Be This Billing Service!

Your front-office staff is great. They check patients in, smile, schedule, and do everything right. The doctor or nurse sees the patient, listening intently for any clue that might help them solve whatever the problem. The patient leaves happy.

Then the bill arrives. The patient has a coinsurance they need to pay, and are very willing to do so, but it appears something has gone wrong with the insurance payment amount. They call the number on the statement to pay the bill, and get a not-so-friendly customer service representative. Things go downhill from there. A month later, the patient comes back into the office beside themselves, acting like a lunatic waving a bill around. Once you bring them into a private room away from the rest of your patients, you find out the problem: The patient has been fighting with your billing company for over a month to get a better understanding of what has happened.

This scenario happens far too many times. The office provides excellent service and the billing department — not so much. What is a practice manager to do? First, try to identify the actual problem and go from there.

Here are some tips on conflict resolution between your practice, the patient, and the billing department.

1. Identify the person in the billing department who the patient has been dealing with. Find out the rest of the story, as it could be the patient only had one interaction with the billing department, and the employee could have been trying to explain that the bill was part of the patient deductible and coinsurance. When patients don't want to hear what they don't understand, they start to argue.

2. Once you have a clear understanding of the problem, find out where the customer service portion of the patient experience failed. If it was lack of follow up with the patient or if the representative was indeed rude, that should be addressed with the billing department's manager.

3. Take this opportunity to create a plan with the billing manager to address overall customer service opportunities within the department and how you would like a very specific level of customer service to your patients.

This should include:

• Friendly customer service representatives for your patients.
• If the patient is not satisfied with the level of service, they should be allowed to speak with the manager immediately.
• Follow up with patients. If the representative says, "Let me call you back on that," a phone call best be made within a specific time frame; in most cases 24 hours in a good rule of thumb.
• • If your office is unsure how an insurance is going to pay a claim and the patient needs to be seen multiple times for similar treatments, it is reasonable to ask the billing department to follow a claim from beginning to end. They can then call and let your office know if the insurance is imposing a copay, coinsurance, or deductible for the patient to pay. Your office can then inform the patient. Good billing departments can get most claims through to the major payers in less than two weeks.

Overall, the billing department is part of your team. They need to be on-board with your requests and policies. If you find there is a lack in this area, it's time to set up a meeting and set some standards for them. You are their customer and should be treated as such.

Article By P.j. Cloud-moulds of Physicians Practice http://www.physicianspractice.com/blog/medical-billing-disputes-finding-peace-between-patients-and-billers?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=24092013

Reduce Medical Practice Embezzlement Risk by Implementing Cash Controls

By Karen Zupko and Cheryl Toth Of Physicians Practice

Several years ago, we visited a practice in which the receptionist drove a Jaguar. We were particularly intrigued about this after we learned that her husband had been in and out of work for several years. As part of our engagement, we observed the receptionist checking in and checking out patients, and noticed fairly quickly that the encounter forms for several patients who paid in cash had "disappeared."

The next day, the receptionist called in sick and within a few days had resigned. In the end it became clear she had been tossing encounter tickets and pocketing cash for years. But because the practice didn't require anyone to account for all the day's encounter forms, nor balance money collected against what was posted to the computer system, no one was the wiser.

Front-desk embezzlement schemes are not uncommon and they are typically the result of loose protocols and lack of oversight. Reduce your financial risk by tightening cash controls using these proven practices.

1. Confirm that all encounter tickets for the day have been posted and "closed." At the end of each day, generate a "missing ticket" report from the practice management system and verify that all encounters have had charges and payments posted to them. This indicates the ticket has been closed. If your practice uses paper, ensure each ticket has a number. If your practice is paperless, the practice management system will generate and store an electronic tracking number. Tickets for patients who cancelled or did not show up for their appointment should be closed with a reason code for "cancelled" or "no-show."

Closing and accounting for all encounter tickets is the foundation of front-desk cash control, yet many practices skip this step. When we asked a neurosurgery group to generate a missing ticket report for the first time, it included more than 600 open tickets from the previous two years. Was someone in the practice on the take? Hard to say. But these days no one goes home from this practice until all tickets are located and closed.

2. Balance the ticket totals, posted payments, and actual money collected. This is standard operating procedure in any retail store or restaurant and should be your standard operating procedure too. Balance all three totals to the penny, and designate a manager or supervisor to review and sign off on the work. Thievery is thwarted when employees know someone is paying attention. For each day's balance, bundle the closed tickets (or equivalent electronic report) with credit card receipts, check copies, and the reconciled total payments collected and file them by day (electronically or on paper).

3. Lock it up. We were stunned to spot an unlocked strong box on the front desk of a small internal medicine group, from which staff and doctors regularly withdrew money for everything from the physicians' lunches to a box of copy paper. No lock, no protocol for who could withdraw money, and no paper trail of what was taken out. The timid manager simply put more money in when the balance was low. Be smart: Keep all money in a locked drawer (or overnight safe), and establish guidelines for who has access and what the money should be used for.

4. Separate the "change fund" from "petty cash." There is a difference. The change fund is an amount in small bills that's always the same — say, $200. This is the money staff use to make change for patients who pay in cash. Every day when they balance to the penny, the amount is counted out and kept in the drawer for change-making the next day.

The petty cash fund is a small account from which you borrow for small purchases. Each transaction is logged on a "chit," and ultimately posted as an expense in your bookkeeping system. When the petty cash fund is low, the manager replenishes it, and records this in the bookkeeping system too. If you don't track petty cash separately from change, you risk an easy-to-play financial shell game that never matches money spent with specific transactions. And it's difficult to spot missing money if there are no controls for reconciling transactions in the first place.

5. Randomly audit no-shows and cancelled appointments to make sure they are valid. In one surgical practice, we uncovered a front-desk staffer deleting appointments using the reason code "no-show" for patients who were seen and paid in cash. How did we catch it? An inordinate number of no-shows prompted us to pull charts. In several we found visit notes for patients who supposedly did not show up for their appointment — when they actually did. Not only had the practice lost the patient's payment, but because the staff person had made these encounters disappear, none of these services had been billed to insurance either.

6. Conduct background checks for EVERY employee who handles money. An attorney colleague is currently working on five cases that involve practice or billing service employees accused of stealing. Background checks should be an essential part of the hiring process. You'll be amazed at how many candidates are up to their ears in credit card debt, or who have been convicted of a crime. Both are clues that the candidate should not be hired to handle money.

Don't wait until after the hire to learn the facts. Companies such as Trusted Employees offer inexpensive background checks for employees of hospitals and physician offices, as well as other industries. (www.trustedemployees.com)

7. Pay attention to the personal situations of staff. A person who cannot pay their mortgage or has racked up thousands of dollars in credit card debt can feel desperate and act in ways they normally may not. Or, in the case of the Jaguar-driving receptionist, the luxury car should have been a signal to the manager and physicians that something was amiss.

Yes, we recognize that physicians and managers are busy. But when it comes to managing people who handle your money, there is no amount of busy that should get in the way of good old acuity and common sense.

Karen Zupko is President of KarenZupko & Associates, Inc., a firm that has helped physicians save time, save money, and reduce risk for more than 25 years.

Cheryl Toth is a KZA consultant and writer focused on technologies and process change that improve practice profitability and the patient experience.

Article courtesy of Physician's Practice: http://www.physicianspractice.com/embezzlement/reduce-medical-practice-embezzlement-risk-implementing-cash-controls?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=03102013

Patient Out-of-Pocket Expenses Rise, Squeezing Physician Cash Flow

Maintaining cash flow is a growing challenge for physician practices now that their "bread and butter" privately insured patients are paying more and more of their healthcare expenses out of pocket, and it will get worse.

Out-of-pocket expenses not including premiums have increased to an average $768 for each privately insured consumer in 2012 according to the nonprofit, non-partisan Health Care Cost Institute, and are projected to skyrocket as much as 50 percent in 2015 under Obamacare’s numerous mandates.

Maintaining your practice’s cash flow requires much more than initiating more aggressive patient obligation collections policies. Payer contracting, practice marketing, and patient-service strategies must change to keep pace.

Payer Contracting

The market will soon be flooded with newly insured and reinsured through exchanges, mostly women because newly mandated coverage favors women and relies on men to share the cost. Employers will be re-evaluating policies and, if they keep insurance at all, will be gravitating to higher-deductible policies to keep pace with subsidized premiums.

Identifying major area employers with whom they insure, and whether or not they have high-deductible policies, is a new must. It isn’t just how much the insurer pays you anymore, it is how much the employee must pay you as well. Upscale employers typically have upscale insurance with higher reimbursements, lower co-pays and deductibles, and employees who can afford to pay them. As obvious as focusing on them as this may seem, going in-network with these payers and competing for their members has not dawned on most, if any, practices as a strategy.

Practice Marketing

Identifying and stratifying the best-insured employees and their families is a key competitive and marketing strategy. Getting those patients established with your practice is goal number one. Strategically, getting in network and understanding their needs is a must. Tactically, your marketing should be keyed to them. Your message should resonate with them. Your practice services should cater to their needs. And, you should be using experienced professionals for research, branding, messaging, and marketing.

Patient Services

Doing things right to gain a competitive advantage requires an investment in time and money. Keeping patients does not. It requires something else except in rare cases: a change in practice culture.

With all of the focus on patient-centered care, there is almost none on patient-centered services despite reams of literature showing that satisfied patients feel better, do better, and bring their friends and family along with them.

Change begins at the front desk with two very simple things: welcoming people and having an experienced staffer answer phones. How patients are treated sets the tone for the rest of the visit and determines the “patient experience,” and it all rests on office culture: Does your practice accept patients, or welcome them?

It all circles back to the beginning with two straightforward quirks of human nature: Happy patients are most likely to pay their bills while unhappy patients are most likely to sue.

For good advice on how to provide excellent customer service, click here.

Collecting Patient Payment during Scheduling

Scheduling is the first contact with the patient and by far one of the most important. It is a time you can obtain all the information needed to check eligibility, notify the physician in advance for the reason of the visit, set the expectation that payment is owed at the time of service, and start building a rapport with the patient.

Obtaining all information needed to check eligibility and perform pre-visit preparation can be time consuming, but is by far worth its weight in collected dollars when reviewing financials at the end of the month.During scheduling, the following minimum information should be obtained:• Patient demographics (name, cell number, address, work number, social security number, date of birth)• Insurance information (ID number, group number, payer ID, guarantor information)• Reason for visit• An answer to the question: Are there records or test results needed before being seen? After the information is obtained, the scheduler should request payment of any balance on the patient’s account. This can sometimes be an uncomfortable process for staff, but by providing staff with scripts and role playing, they can perfect the process in no time.  It can even make patient collections feel natural. For example, instead of saying, “Ms. Smith you have a balance on your account. Would you like to pay that today?” Train your staff to say, “Ms. Smith I see you have a past due amount of $50.How would you like to take care of that today? We accept Visa, MasterCard, or do you have a FSA card?” It is amazing how many more payments practices can collect, just by being prepared and having the proper scripts in place.
Once the practice has obtained all the needed information, checking eligibility and benefits in advance is a piece of cake. The process should no longer be considered an option for practices today. It is estimated that only 41 percent of providers collect at the time of service, while 36 percent collect at the time of service some of the time. This is surprising considering it costs approximately $7 a statement (if not sent electronically) and eligibility costs between $0 to $0.74. So at worst-case scenario the practice saves $6.26 per patient if the money is collected at the time of service. If the patient is sent more than one invoice the number continues to increase.

 Let’s compare the two different approaches:

Collection at the time of service (patient responsibility minus cost of eligibility check):
• $50- $0.74 = $49.26

Patient is billed for amount owed (patient responsibility minus cost of statements):
• $50 – 7= $43 (1st statement)
• $43 - $7= $36 (2nd statement)
• $36 - $7= $29 (3rd statement)

(If utilizing an electronic statement process the cost for three statements can vary between $2.25 to $5 depending on the process and vendor).

Comparing the two scenarios, it seems there would be no question as to which process is more efficient, but 49 percent of providers are still using the second scenario. In previous years, it was a cumbersome process to investigate patient responsibility in advance. Many times insurance feedback would not be current or correct. This in turn made the process frustrating and in many cases a waste of time and money. This made it understandable why many practices avoided the process. However, today the process could not be easier. There are various options for practices depending on their practice-management software and clearinghouse vendor.

These options include:

• Automating the process by utilizing your practice management software if offered. This will allow the practice to set up the system to check eligibility and benefits in advance before the patient is seen without staff utilizing time to retrieve the data. The information is commonly imported directly into the patient’s chart and can be viewed immediately.
• If automation is not an option for checking eligibility and benefits then centralize. Centralization can be done by utilizing a clearinghouse or other vendors that specializes in these types of services. (Tip: Make sure the vendor works closely and is compatible with your practice management software).
• Lastly, if the above options do not work, practices should go directly to their payers’ websites or call their payers. This option is more time consuming and costly considering hourly employees are performing the process manually, instead of automating after hours.

Once the process has been determined, the criteria must be decided. The information should be obtained at minimum of three days in advance of the appointment. This will allow the practice to compare the patient coverage to their fee schedule. By comparing the two, the patient responsibility can be estimated in advance, allowing the practice to contact the patient in advance. The more the process is utilized the more savings the practice will endure over time. This allows the practice to not only know patient financial responsibility, but also issues with insurance or coverage such as invalid insurance ID or that the service will not be covered.

Regardless of the method, the key is being prepared. Once the practice is prepared the practice can reach out to the patient to discuss their financial responsibility and payment expectations before treatment is performed. Before reaching out to the patient regarding their responsibility, the practice should have insight as to what will be owed. In order to calculate responsibility, fee schedules and contracts will have to be examined and compared by the practice to the patient’s coverage. Many practice management software programs have the ability to calculate this information, if it is set up and maintained properly. If the practice management software does not have the functionality, the information can even be calculated by utilizing an Excel spreadsheet if needed.

Once the amount owed is calculated, the patient counselor should contact the patient regarding the balance. The patient counselor should have strong customer service skills with a high level of billing knowledge, and the ability to be compassionate and considerate when speaking to the patients. Many times if handled properly, the patient will pay in advance or set up payment arrangements before being seen in the practice. More importantly, the patient is entering the practice with an understanding of their financial responsibility and can take ownership of the bill.

Healthcare is one of the few expenses that can unexpectedly occur but be as high as the cost of an automobile or mortgage. Isn’t it only fair we prepare our patients and set the expectation that money is to be paid at the time of service?

Article By Chastity Werner, RHIT
Courtesy of: http://www.physicianspractice.com/blog/collecting-patient-payment-during-scheduling?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=10092013

Getting Patients to Pay Early at Your Medical Practice

In many parts of the country, the economy is still in recovery while healthcare costs are continuing to rise. The end result for physician practices? More stress when it comes to getting patients to pay in a timely manner, and less-than-ideal collection rates.

Technology now allows practices to offer prepayment services to patients. But can such technology really help a practice collect payments at (or even before) the time of service? And will patients actually take to the idea of paying earlier rather than later? For Holly Springs Pediatrics in Holly Springs, N.C., the answer to both these questions is yes. But there has to be a good incentive in place. “It’s very hard getting money from people up front,” practice billing manager Judy Downing told Physicians Practice. “With the economy the way it is, we have so many people out of work. And they don’t look at a doctor’s office as an actual business. They look at it as ‘oh, let me bring you my chicken, and we’ll trade this chicken for your healthcare.’” Tapping into its eligibility verification technology from its billing vendor, InstaMed, which is integrated with its Office Practicum practice management software, Holly Springs Pediatrics recently started offering “prompt-pay” benefits for patients who pay their bills early. Charges are based on the estimated cost of the medical services. “We give them three different options,” said Downing, noting that these options are presented in a self-pay agreement form. “They can pay the estimated charges and receive a 30 percent discount if they pay the balance in full. Or they can pay 50 percent of their estimated charges and if they pay within 30 days, they get a 20 percent discount. They can pay a minimum payment and make an arrangement with the billing department.” By offering these three options, practice has improved collections, and is seen as more flexible by patients. It has also reduced patient no-shows. “We have had a lot of success with people paying it because they get that discount,” said Downing.Aspen Valley Hospital, which uses the same InstaMed program, has also seen a 124 percent increase in collections over the last four years since it started offering a 20 percent adjusted discount off the patient’s portion of the bill for paying in full at the time of service. Along with their two satellite practices, the hospital initially offered a 5 percent discount but found the 20 percent discount to be more successful.  Additionally, the practice reduced overall patient collection costs by 65 percent. “We start by telling a patient when we schedule, then the financial counselor will call and go over the expectation and say, ‘by the way, we offer 20 percent [adjustment] if you take care of your payment in full,” Debby Essex, the hospital’s director of admissions, told Physicians Practice. “Also, there’s a call before the patient comes to the front desk, and when they come to the front desk. They’re fully informed.”

Article by Marisa Torrieri
- See more at: http://www.physicianspractice.com/blog/getting-patients-pay-early-your-medical-practice?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=03092013#sthash.wgmU6iRC.dpuf

Revenue Cycle Management Is More Than Billing Patients

Revenue cycle management (RCM) is the lifeblood of any practice — private or nonprofit. Effective patient registration, insurance and benefit verification, charge capture, and claims processing are essential to maintaining practice viability. Before you can improve any process, you need to assess where you are now. Here are some questions you should think about:

• Do you know if you are achieving best practice standards in accounts-receivable management? • Does it take your practice too long to collect, and/or are your write-offs and adjustments too high? • Do you know your claim-denial rate on first submission (4 percent of claims or fewer is best practice)? • Have you determined that you are not leaving any money on the table with a reimbursement analysis? • What are your days in A/R? What percentage of your accounts receivable is more than 120 days old (10 percent or less is best practice)?

Patient registration The revenue cycle starts with patient registration. Patient registration begins with a phone call for an appointment request. Your front-desk staff should interview the patient on the phone to collect billing and insurance information;  invite the patient to go online to your website to complete their registration information; and follow up if registration isn't completed two days prior to the appointment — so that the patient's insurance coverage can be verified. You can use an in-office kiosk for patient check in and to collect demographic information. Some kiosks will automatically verify insurance eligibility too.  Charge capture Transferring patient charges from the EHR to your practice management (PM) system should be seamless — electronically transmitting data is an example of efficient workflow. But, if you are forcing your providers to first complete a paper visit-encounter form, and then transfer that information to the EHR, it can lead to inconsistencies, lost data, and redundant work processes. Furthermore, asking your check-out station to compare electronic patient information against the paper encounter form is burdensome and creates even more work when discrepancies arise.  Automatic payment posting Automatic payment posting can significantly reduce staff work, so why don't more billing staff embrace and drive implementation of auto-post opportunities? Holding tight to the status quo — manual payment posting and reconciliation — is an inefficient use of our most costly resource: staff. Routinely ask your payers, clearinghouses, and software vendors about new services coming online, and roll out every new payer as electronic remittance and auto-posting become available. Investigate a bank lockbox service that converts the paper explanation of benefits (EOBs) to electronic transactions (837s) for automatic posting to patient accounts.  Insurance eligibility verification Investigate and incorporate automatic insurance eligibility verification into your work flows. You can use your clearinghouse service to upload the appointment schedule a couple of days in advance, in a batch process. For walk-in patients, use real-time verification through your PM system. An integrated verification solution creates a history within the patient's record that supports follow-up collection efforts, if there are later discrepancies with the payer.

Article by Rosemarie Nelson - See more at: http://www.physicianspractice.com/billing-and-collections/revenue-cycle-management-more-billing-patients?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=29082013#sthash.Bbvb2ywQ.dpuf

What to Do When Services are Not Paid by a Commercial Payer

If a practice is contracted as a participating provider with commercial insurers and networks, it must pay close attention to the patient "Hold Harmless" sections of the agreements. Many agreements prohibit billing the patient for services that are unpaid due to the insolvency of a payer (which may be the insurer or a self-funded employer), when the payer deems a service not medically necessary, for lack of compliance with utilization programs, or for failure to file a claim in a timely manner. Some agreements even go so far as to prohibit a practice from having a waiver signed by the patient in which the patient agrees to be responsible in these circumstances.

The best way to protect a practice so that it can bill the patient for services not paid for by the plan is twofold:

1. Re-negotiate the language in agreements in the Member Hold Harmless provision, sometimes called "Billing the Patient," or the like, to more favorable language.
2. Implement a patient financial responsibility statement / waiver* and signature process so that your patients acknowledge their responsibility to pay during these circumstances.

In re-negotiating the contract language, be sure the terms reflect that it is "only when required by applicable law" that you will not bill the patient / member under the circumstances that the plan is insolvent or has determined that the billed services are not medically necessary. In many states, practices are bound by such provisions by state regulations, but only with respect to state regulated HMOs and certain fully insured or government plans. These plans are generally required by law to retain reserves that will pay claims for a matter of months should the plans become financially unstable.

The majority of the members / patients that practices see under most agreements are in self-funded plans that operate under the federal Employee Retirement Income Security Act (ERISA). These plans do not have the same regulatory reserve requirements as the plans discussed above, and the contract should reflect that a patient waiver for such plans can be used to hold patients financially responsible if a self-funded plan does not pay for any service. The risk of a self-funded plan going belly up overnight and not having funds reserved to pay recent claims is therefore much greater. If a practice signs a network agreement that says that it can never bill the member for services not paid for by the self-funded plan, even in the case of insolvency or when the plan determines the service to be medically unnecessary, then billing the patient is technically prohibited even when there is a waiver signed by the patient agreeing to pay for claims in these cases.

In revising your patient responsibility statement or waiver for patients covered under private payer plans, be sure to specifically include the patient's promise that he or she will be financially responsible, as allowed by applicable law, in the event that:

• His or her insurer or self-funded employer does not pay the claim in a timely and accurate manner
• The insurer or payer deems the service to be either not medically necessary or to be an excluded or non-covered service
• The payer or insurer denies the claim for lack of timely filing or adherence to utilization or payment policies
• A claim is prospectively or retroactively denied due to lack of eligibility or benefits

Although the practice is obliged to adhere to utilization management programs and payment policies in most agreements, many payers' programs and policies are not readily accessible, especially when leased networks are involved. The patient needs to be financially responsible and compliant with program requirements. When a multitude of claim administrators and employers are renting a network such as Multiplan, Galaxy, or Three Rivers Provider Network, each party leasing the network may have unique programs and policies that are not found on a central web site or portal. There can be some very good reasons to contract with leased networks, but these varying policies can make monitoring those who rent the networks more challenging. Sometimes these networks are less likely to modify the hold harmless language so as to appease all of their renting parties.

In addition to the hints provided above, when defining and administering the terms of the patient responsibility statement / waiver, the practice should be prepared to advise the patient in advance of denial, if it is aware that a service may not be covered. Provide the patient with the likely cost and payment terms that will be accepted, preferably in writing, including any prompt pay or hardship discounts that might apply. This type of communication can assist you in managing the patient's expectations and his or her commitment to timely payment. These extra steps can also add to the practice's compliance with the newly negotiated and more favorable hold harmless terms.

 

From the Jan/Feb issue of HBMA Billing by Penny Noyes http://www.hbma.org/news/public-news/n_what-to-do-when-services-are-not-paid-by-a-commercial-payer

 

Tracking Patient Collections a Necessity at Your Medical Practice

As a physician, do you know how many patient collections (copay, coinsurance, deductible, etc.) are paid by credit card, check, or cash? You might be surprised to know that cash is still a very viable form of payment by a lot of people. With so many people out of work, they have to budget their money very carefully. One way they are doing this is really buckling down on expenses and using cash as often as feasibly possible. It makes sense, really, to those who are disciplined enough to not impulse buy.                   

This said, do you have a way of tracking the money coming in and the money going out of your practice? I really hate to be the person who points this out, but under certain circumstances, even your most trusted front-desk person might "misplace" some of the cash that should be deposited into your bank account. Many employees don't understand and don't have all of the information about the financial health of your practice; nor should they. Their mindset might be, "They have enough and I'm barely scraping by (because I just bought that third pair of really cute shoes)." For whatever reason, money may be leaving your facility without your knowledge.
Here are some ideas to stop this now and prevent this temptation in the future.

• Create a simple spreadsheet that can be placed in the desk of the front-office staff collecting the copays. This should include the patient name, description of the money in, or money out, the amount that was paid, and today's date.
• At the beginning of each day, the front-office person counts the money in the cash box. Any money over a set amount (by you – say $100) should be "deposited" to you or your practice administrator. Those monies then need to be tracked and deposited in the bank with a deposit slip showing this same amount.
• Throughout the day, the front-office person will write down every single payment (cash or not) on the spreadsheet. This can also be a digital document, programmed to record all calculations. The reason you need to write down every single payment is because this will ensure that each patient who owes has been collected on.
• If someone in the office borrows money for an employee lunch, office supplies, etc., that needs to be recorded and calculated in a cash-out area at the end of the day.
• At the end of the day, all the money in and out should balance. The front-office staff is required to manage the cash flow of the practice. The practice administrator or manager needs to sign off on a weekly basis, how the week's in and out activity has occurred.

By following these simple steps, it will insure your practice collects what is necessary, patients do not receive a bill, money get deposited into your bank account, and there are no questions of where the funds have gone.

Article By P.j. Cloud-moulds
- See more at: http://www.physicianspractice.com/blog/tracking-patient-collections-necessity-your-medical-practice?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=20082013#sthash.jv2859XU.dpuf

Latest Trends and Best Practices for Collecting Healthcare Payments

An article by Bill Marvin, taken from the July/August issue of HBMA Billing (hbma.org)
The healthcare payments industry is growing and changing rapidly, and this change is influencing the way that many in the industry, including billing services and their clients, do business. Data from the 2012 Trends in Healthcare Payments Annual Report shows that as the healthcare payments industry evolves, billing services must take steps to accommodate these changes.
Efficiency, payment best practices, interoperability, and security will be crucial areas to focus on in the future as the industry continues to change and grow. Below are the key market trends featured in the report that identify how billing services can prepare for the future in the healthcare payments industry.

1. Simplify the Payment Experience

Of providers surveyed, 37 percent said that their primary revenue cycle concern is the increase in patient responsibility.
As patient responsibility continues to rise, patients have more influence in the healthcare payments process. By delivering additional channels for consumer payments, billing services and their clients will collect more payments
Of providers surveyed, 83 percent said it took more than one month to collect from a patient after claim adjudication.
Today, billing services send out multiple paper statements and make follow-up phone calls to collect patient payments. Facilitating payments at every patient interaction point will be a key factor in reducing the time and costs to collect.

2. Expand Payment Channels

Of patients surveyed, 72 percent said they would like to pay their healthcare bills online.
It is estimated that U.S. consumers will spend more than $300 billion online in 2016. To collect more payments, billing services and their clients must look to the online payment best practices used in other industries to meet patient payment expectations as consumers.
In addition to leveraging technology, billing services must foster cultural changes among staff and patients to better prepare staff members to collect and for patients to pay. Tools and policies such as prompt pay discounts, staff incentive programs, minimum payment requirements, and scripts to use when discussing payments with patients are effective ways to collect more revenue.

3. Achieve Interoperability to Increase Efficiency

Of providers surveyed, 71 percent said that a lack of system interoperability is a major barrier to health information exchange.
Continuing provider consolidation will drive a greater need for system interoperability. The industry must also focus on administrative interoperability, including payment-related systems and processes. By integrating heterogeneous systems, billing services and their clients will automate more processes, simplify compliance requirements, and streamline employee training.

4. Focus on Data and Security

In the last decade, cloud usage in the U.S. has grown by more than 150 percent.
As billing services deliver more channels for consumer payments, private cloud technology will be crucial to efficiently collect, post, and reconcile all payments. However, cloud usage also presents new risks such as long-term downtime and loss of data during disasters. To protect data in the cloud, billing services must ask cloud vendors about disaster recovery and prevention policies and procedures.
In 2012, 27 percent of all reported data breaches occurred in the healthcare industry.
As patient payments increase, more consumer payment cards and bank accounts are exposed, which greatly increases the risk of a data breach. The financial and reputational costs of a payment card data breach are high and may result in bad publicity and loss of business. To reduce the risk of a breach, billing services should consider implementing methods to ensure payment card security and to meet the Payment Card Industry (PCI) standards more easily. In order to protect sensitive information when collecting payments, organizations will leverage new technology such as encryption at the point of interaction (POI) and prepare for the upcoming mandate around Europay, MasterCard, and Visa (EMV). The new EMV standard requires payment card issuers to include a chip that will add a layer of authentication to go along with the current magnetic strip on the back of cards. The industry is quickly beginning to issue and mandate processing for chip-based cards, including:

• Starting April 1, 2013, banks and financial institutions were required to process EMV chip transactions.
  
• Starting October 1, 2015, liability for counterfeit transactions will shift to merchants when processing an EMV card transaction on non-EMV capable devices. Additional information can be found at en.wikipedia.org/wiki/EMV.

Article source: 2012 Trends in Healthcare Payments Report, www.instamed.com/trends-in-healthcare-payments-annual-report-2012.

Follow This 3-Step Advice Before Waiving Copays

Follow This 3-Step Advice Before Waiving Copays

Tip: Get your own verification of financial hardship.

Every Physician wants to collect his due payment, even if it accumulates in small amounts through copays or deductible. Though you often hear advice pointing you away from offering discounts or waiving fees, there are times when that approach can be your best option. Our experts share three steps to properly waiving patient fees based on financial hardship.

1. Understand the Exception to the Rule

Routinely waiving deductibles and copayments can violate several federal laws and regulations, including the federal False Claims Act, anti-kickback statutes, and compliance guidelines for individual and small group physician practices. Doing so may also violate payer contracts.

In black and white: "Physicians or suppliers who routinely waive the collection of deductible or coinsurance from a beneficiary constitute a violation of the law pertaining to false claims and kickbacks," CMS says in the Medicare Claims Processing Manual, chapter 23, section 80.8.1. This applies not only to Medicare payers, but also those private carriers that base their regulations on Medicare rules.

Even though the rule is that you shouldn't offer waivers and discounts, you can make exceptions based on financial hardship-- if you follow a few guidelines.

"Waivers or discounts... should be made only on the basis of demonstrated patient financial need," says Barbara Colburn, president/CEO of B.C. & Associates Management Corp., a Wisconsin-based health care consulting/billing organization. According to Colburn, you must meet the following criteria:

1. You do not offer the waiver as part of any advertisement or solicitation
2. You do not offer waivers routinely to patients

You offer the waiver after determining, in good faith, that the individual is in financial need or after reasonable collection efforts have failed.

"In offices that i managed we always had the option of a financial hardship waiver but it was usually offered only after all the other means of collecting were exhausted such as insurance, payment plans, etc." says Marge McQuade, CMSCS, CMM, a consultant in Florida.

Note: You can offer discounts to patients with no insurance who are self-paying without proving financial hardship. Offering waivers or discounts to insured patients, including Medicare patients, "may be suspect unless they are non-routine and related to genuine hardship," Colburn says.

Pointer: "Have a financial policy in place about how you handle patients with financial hardships," advises Catherine Brink, CMM, CPC, CMSCS, owner of HealthCare Resource Management, Inc., in Spring Lake, N.J. "This is very important since it ensures you don't 'discriminate' how you handle finances with your patients."

2. Get It in Writing

Don't just take the patients word for it when it comes to financial hardship. Before you agree to debt write-off, the patient needs to be able to prove he is unable to pay.

First, document the effort you took to collect the money. "Where a physician/supplier makes a reasonable collection effort for the payment of coinsurance/deductible, failure to collect payment is not considered a reduction in the physician's/supplier's charge," CMS says in the Medicare Claims Processing Manual, chapter 23, section 80.8.1. "To be considered a reasonable collection effort, the effort to collect Medicare coinsurance/ deductible amounts must be similar to the effort made to collect comparable amounts from non-Medicare patients. It must also involve the issuance of a bill to the beneficiary or to the party responsible for the patients personal financial obligations. In addition, it may include other actions, such as subsequent billings, collection letter and telephone calls or personal contacts which constitute a genuine, rather than token, collections effort."

If you want to prove financial hardship, you'll need to ask the patient to provide you with information such as income tax returns and W-2 and 1099 forms as proof of income and essential monthly household expenditures, such as mortgage/rent, utilities, insurance, and food.

You'll then use this information to determine whether the patients earnings meet state and federal poverty guidelines. "Make sure you work within the poverty guidelines for your state," McQuade cautions.

Official Guidance: The Office of the Inspector General (IOG) states, "we do not believe it is appropriate to apply inflated income guidelines that result in waivers for beneficiaries who are not in genuine financial need."

The patient and the physician should also sign a statement detailing that the practice reviewed proof of financial hardship and listing what charges the practice is waiving. You practice should keep a copy and provide a copy to the patient as well.

"The provider should keep up with legal developments related to discounts and waivers of co-payments and deductibles," Colburn explains.

Key to success: You also should only apply the determination of financial hardship to the particular visit or service you are billing for at the time, not to any future services.

3. Don't Avoid Collections If Waiver Is a No Go

If a patient applies for financial hardship but your practice deems that the patient does not meet the qualifications for a waiver, you should send a waiver denial form. But don't let that stop your collections efforts and end up in a write off. You then need to proceed with billing the patient and letting him know you expect payment.

Option: "If a patient applied for financial hardship and doesn't qualify, the next step would be to offer a payment plan for the patient, depending, of course, on the amount the patient owes and at what point you are doing the waiver (after insurance, self pay with payment plan first, etc.)," McQuade says.

"For example, ask for a credit card to keep on file that you would charge, say $50 each month," agrees Brink. "Have the patient sign this financial agreement." If the patient doesn't have a credit card, then set up a financial payment plan signed by the patient stating that he will pay by check or cash by a certain day of each month and the amount he will pay plus the date the balance will be paid in full, Brink adds.

Courtesy of: The Coding Institute: Family Practice Coding Alert

3 Easy Ways to Increase Your Medical Practice Revenue by 25%

There are a hundred ways to streamline workflow and improve revenue in a medical practice. It’s hard to pick just a few, but in this guide, that’s just what we have done.

Here are three simple suggestions that any practice should be able to implement that can generate an increase of at least 25% revenue.

And they cost little or nothing to implement.

1. Make Money on Prescription Refills
Prescribing is a big deal for most practices. Many report the greatest percentage of in-bound phone calls to their practices are prescription related. Either the patient is asking for prescription refills or pharmacy personnel are seeking approval to fill a script. Have you ever considered how much this process is costing your practice? Have you ever asked, “How can we be compensated for this time?”
Who makes money when prescriptions are filled? Perhaps the more important question is who does not make money on prescription refills. Today, most commonly, the pharmacist is benefiting the most from the prescription renewal process. Sure, the pharmaceutical manufacturers are also making revenue from the sale. Unfortunately, the biggest loser in this process is the medical practice. But it doesn’t have to be this way.
How much does the prescription refill process cost your practice? Every patient or pharmacist contact for a prescription refill creates a cost to the practice. What is the overhead cost in your practice for the following functions? • Taking a message • Pulling a fax off the fax machine • Pulling a chart • Provider reviewing the chart • Authorizing the refill • Calling or faxing in the prescription
Even if your practice has automated some of these functions, there still is a cost, and it is important for you to calculate it.
Is it possible to transform this cost into revenue? The temptation is to believe that the prescription refill process is just a cost of doing business. It doesn’t have to be this way! The fact is that a prescription policy can generate additional revenue for the practice and offset that cost.
This policy outlines how refill and other prescription requests are handled. It should include a follow-up period for chronic disease patients. Generally, they should be seen every 90 days for evaluation and review of medications. It can be billed as 99213 with an average reimbursement of about $70.00. Also, consider including something in the policy for patients who call with acute symptoms and are “experts” at self-diagnosis. They may call and request that a prescription be called in without a visit. Your policy should focus on eliminating prescribing in these cases and getting those patients in for an appointment, ideally the same day. If you have mid-level providers, they can perform these types of services. Make sure all staff are well-versed in the prescription policies and that those policies are clearly conveyed to patients. If needed, you can create talking points for staff to help them with the change.
The average practice can spend anywhere from $4.00 to $15.00 for every single prescription refill event.

2. Use Your Schedule to Maximize Visits
Time really is money for most healthcare providers so your goal should be to see as many patients as possible each day. Unfortunately, physicians historically haven’t been good at using their schedules to generate income. So your front office staff needs to learn to be strategic in their scheduling process because every unfilled appointment represents a loss of income.
Analyze Your Patient Mix Are they primarily fee-for-service (FFS) or capitated? FFS patients pay for services one-by-one where capitated patients have a set fee that has been paid for services performed.
Fill your schedule based on the mix of patients. If you have 70% FFS and 30% capitated your schedule should reflect that, and you should triage patients accordingly as well. Try to schedule capitated patients only in your blocked capitated spaces while leaving same day and extended hours open for FFS patients. Don’t book capitated patients in the same-day slots unless necessary. You don’t want to lose the revenue from FFS patients, and they may go elsewhere if they can’t get in to see you promptly.
Categorize Your Visits You have many types of visits. Some take longer than others. A new patient visit takes a lot longer than an established patient. Acute patients are different than visits for preventive care.
Do an analysis of the types of appointments you have. Once you have identified those visits, look at how much time each visit takes and what resources need to be scheduled. You can then customize your scheduler with your practice resources (providers, rooms, equipment, etc.) and place appointments at times of the day where it makes the most sense.
For example, put longer, new patient visits at the end of the day while shorter visits can be placed earlier in the day.
If you can schedule by resource, you can also book more than one patient for the same or overlapping time slots. Having more control over your scheduling helps you get more patients each day and helps you improve their experience by reducing wait times.
Developing the perfect schedule for your practice may take some work and even some trial and error but in the end, you’ll find it’s worth it.
Consider Double-Booking According to Medicaid, one in three patients doesn’t show up. Other studies suggest 25-50% of follow up patients cancel or don’t show. Look at your schedule to identify groups of patients who are most likely to cancel or not show up. Consider double-booking those types of patients or appointments. Also, consider changing the way you discuss some of these types of visits with patients. For example, say “See you in five days” and have the patient schedule a follow up versus “Call us if you aren’t feeling better.”
Create a Cancellation/No-Show Fee Patients who cancel appointments or surgeries at the last minute can be a huge drain on your practice’s cash flow. Since you are already streamlining your schedule, consider also implementing a strategy to prevent unexpected holes to minimize the impact of last minute cancellations and no shows on your medical practice.
Set a cancellation policy, and be sure it’s communicated to every patient. Ideally, this takes the form of a document that new patients sign when they first come to the practice. Afterward, make it a point to discuss your policy at the time of booking subsequent appointments or surgery, and when reminder calls or emails go out to patients.
In the cancellation policy, many practices require patients to cancel their appointment at least 24 hours before their scheduled appointment time. For surgeries, the required notice time can be even longer. For those patients who do not comply, consider charging a late cancellation fee.
Collecting cancellation fees can be achieved much more easily than you think when your office is set up to bill for cancellations and accept credit card payments. By creating a cancellation code, you can bill the patient using electronic statements. The day of the cancellation or no-show, process a patient statement and direct the patient to pay online by credit card. Enabling patients to pay online can increase patient payments and speed the turnaround on those payments whether it is for the cancellation fee or for standard co-pays and deductible payments.
3 Easy Ways to Keep Your Practice on Schedule
It may be one of the biggest challenges in a medical practice—staying on schedule. Physicians get sidetracked with refill requests, reviewing labs, returning calls to patients. Patients take up more time than they are allotted. A registration person calls in sick and your front desk gets a little behind. There are a hundred reasons why you might get off track. But once it happens, it’s hard to get that time back. You may find that your practice is slightly behind for the rest of the day. Here are a few simple strategies that might help avoid bottlenecks or turn things around when they start to go south.
1. Easiest: Set clear guidelines for staff about not interrupting the physician with calls or questions between appointments unless it is a true emergency.  Establish a process for the physician to receive messages and manage tasks at specific times of the day—first thing each morning, at the end of the day, perhaps a break at midday. He or she can take care of refills or return calls during those appointed times.
2. Easier: Prioritize tasks for staff. Make sure your staff know what their top priorities are so that if they get busy they know what to let go of for the time being. Sometimes people are trying to do too much when they should just be focused on moving patients swiftly through their appointment. 
3. Easy: Do an analysis of your time management, including your scheduling process and task management. You may need to look at your days from nuts to bolts. Is your schedule inefficient? Maybe the problem is that your longest patient visits are at the wrong time of day and they are causing backups everywhere else. Perhaps your providers just aren’t managing their tasks well. Many practice management and electronic health record systems offer task management tools. If everyone isn’t using them to stay on top of tasks and priorities, now might be a good time to start.
In the end the most important things to remember when trying to keep things on track are making sure that everyone knows exactly what their role is, what their priorities are, and what they should do if things get busy.  Sometimes the problem is simply that people don’t know what to do next to keep things on track and they flounder.
According to Medicaid, one on three patients doesn’t show up.

3. Mine Your Data to Increase VolumeNow that your schedule can accommodate more patients, you need have to get the patients to make appointments. At no extra cost to you, you can mine the data in your medical billing software to market your practice and increase volume.
Reach Out to Your Patients According to the Medical Group Management Association, you should be spending 1-3% of your practice revenue on marketing. If you aren’t marketing your practice, reaching out to existing patients based on your own data is a good, and essentially free, way to start. If your initial efforts are successful then you can decide if it’s worth it to invest a little more to send mailers or do other marketing outreach.
Your practice management and medical billing software is full of information that you can use to increase patient volumes and revenue. Dig into your data and run reports to identify the following types of patients (depending on your practice): • Patients with chronic conditions like diabetes, hypertension, and heart disease who are due for a follow up appointment. • Patients who may be due for physicals, well-woman or well- child checks, and other preventive care. • Anyone who may need immunizations, including annual flu or pneumonia shots.
Once you identify patients you can contact for appointments, be sure you have a process in place to do the reminders via mail, email, text, or phone. Also, make sure you’ve completed step two above and your schedule is setup to accommodate an increase in patient volume.
Implement Staff Incentives By maximizing your schedule and reaching out to patients to make appointments, you’ve created more work for your staff. You might be inclined to say, “Hey, that’s their job.” But your staff is more likely to work hard to get those patients in the door if you set a clear goal for your increase in appointments and reward staff for achieving that goal.
For example, if you decide that the goal is to increase patient visits in the first quarter by 10%, offer a bonus of some kind if your practice reaches this goal. It could be gift cards or a party—whatever you think your staff would like. You can do straight cash bonuses if you think that will work best. Show your staff that their hard work is appreciated and that increases in patients and practice revenue will benefit everyone.
Tap Into Payer Incentives There may be some added bonuses to this process. Some payers are now offering incentives for certain preventive care actions or chronic care follow up. Because incentives can vary widely by payer, state and even specialty, you’ll need to contact payers to ask about incentives. Reaching out to patients, may help your practice to tap into free money from those health plans that are providing financial incentives for meeting quality indicators.
The End Result There are a lot of ways to streamline your practice functions, reduce costs, or increase revenue. But these three options can apply to almost any practice, cost little or nothing to implement, and are virtually guaranteed to increase your revenue.
Courtesy of: Kareo

5 Best Practices for Using Payment Plans to Ensure Patient Payments

What You Need to Know

An article by Bill Marvin, taken from the May/June issue of HBMA Billing (hbma.org)
As health insurance premiums continue to grow (at an average annual rate of 7.1 percent [AHIP 2010]), employers are switching to lower cost, high-deductible health plans. This trend is resulting in an overall decrease in payor payments and a consequent increase in patient payments. This will continue throughout the next decade as the Affordable Care Act rolls out. As a result, billing services and their clients are more dependent on patients for revenue. To collect more from patients, many billing services have started to use patient-centered strategies, such as payment plans. However, to improve results and increase efficiency for their clients, billing services need to ensure that they have implemented best practices.

A Growing Trend

Data from the 2011 "Trends in Healthcare Payments" report shows that the use of payment plans for healthcare payments has doubled since 2009.1 In the same report, 63 percent of surveyed patients said that they would utilize payment plans for their healthcare bills if given the option.

Five Best Practices for Successful Payment Plans

1. Automate Payments
   Many billing services support payment plans manually by managing a calendar that shows when each payment is owed and by calling patients to collect every month. This method is a step in the right direction, but it adds to the billing service's work effort, does not ensure payment for the client, and has security flaws. Whether the payment plan is set up while the patient is in the office or after a statement is sent, billing services and their clients should securely collect and store payment information so they can automatically collect payments when they are due.
   
2. Automate Communications
   Even when a patient authorizes automated monthly payments, he or she may still forget about the payment until it shows up on their next statement, which may create confusion and costly chargebacks. Improve communication and offer payment transparency by automating email notifications to patients prior to each payment transaction
   
   Tip: Provide clients with a one-page "FAQ" for patients explaining how payment plans work, including payment timing, notifications, and payment card security.
   
3. Draw a Line
   It is great for billing services to give patients some flexibility and choice in how much they pay each month, but it is also necessary that they set parameters and stick to them. As a standard best practice, billing services should charge a minimum monthly payment of $100 or require that the bill be paid in full within 12 months.
   
4. Collect Something Upfront
   Payment plans work well for patients who are unable to pay the full bill at once, but billing services should avoid allowing payment plans to become a way for patients to put off paying at all. Establish a policy that patients must pay a certain percentage of the bill upon setting up a monthly payment plan.
   
5. Tailor Payment Plans to Patient Needs
   Depending on the scenario, there are three main types of payment plans to offer patients:
   
   
   • Installment: Collect payments against an outstanding balance and deactivate the plan automatically when the total balance is paid.
   • Recurring: Collect payments at a regular, ongoing interval as a subscription service.
   • Save on File: Save a patient's payment card on file to collect the remaining amount owed when the claim is adjudicated. This is useful when the patient's payment responsibility is unknown during the patient visit; for example, if the patient has a high deductible.

By following best practices when offering patient payment plans, billing services can ensure payment for their clients, even from self-pay or high-deductible patients. Automated, scheduled payment plans save billing services a lot of time and costs to send multiple patient statements and make follow-up calls to patients as well as improve patient communication and clarity around the payment process.

 

Courtesy of: HBMA http://www.hbma.org/news/public-news/n_5-best-practices-for-using-payment-plans-to-ensure-patient-payments

American Medical Assn. V. United Healthcare

http://www.youtube.com/watch?feature=player_detailpage&list=PL76E72A2E143FAD10&v=8VXig5TvxK0