Gastroenterology Coding Alert

Don’t let even a single claim slip through the cracks.

As the coronavirus pandemic continues to take hold of the medical industry, many GI practices are finding that their incomes have drastically fallen due to a reduced patient flow and a stark difference in the number of procedures they can perform.

Although many states have started allowing practices to schedule and perform non-emergent procedures once again, several gastroenterologists have written to Gastroenterology Coding Alert to ask for advice on how to boost their collections to offset the financial losses they’ve taken while their doors were closed.

We’ve pored over the most common queries our readers submitted and gathered some advice on how to boost accounts receivables to offset these losses. Consider these tips as you work to bring in the income you’re missing due to the pandemic.

Don’t Let Even 1 Claim Go Unmonitored

If you do nothing else to tighten up your billing process, at least take this one key tip to heart: Pay attention to what happens to every claim you submit. Follow the claims through the submission and payment processes so if a claim is delayed, you can follow up quickly.

If you bill the claim and forget about it, you’re likely to fall so far behind in your accounts receivables (A/R) that you may end up with a mountain of claims that haven’t been paid. If your claims are rejected, denied, or simply fall through the cracks, you won’t know to rework those claims unless you’re tracking them. In some cases, claims sit in a clearinghouse with no action, but practices that stay on top of them will be able to pinpoint where the claims are in the process so they can follow up on any missing money.

Your billing software may allow you to set an alert to notify you when a claim hasn’t been paid, but if not, you can do this manually. Some practices set aside a day each week to follow up on claims, while others will take an hour or so every morning to track denied/missing claims and see where they are. The method is up to you, as long as you’re making sure you are aware of every claim’s place in the process.

Review, diversify and find less expensive methods to send patients balance bills, advises Glenn D. Littenberg, MD, MACP, FASGE, AGAF, a gastroenterologist and former CPT^® Editorial Panel member in Pasadena, California. “Snail paper forms are expensive and lots of options exist. Reminders can be pinged through a variety of methods. And of course review the variety of methods you can use to collect payments — over the phone, your portal, online via your website, allowing for patients to directly debit their bank accounts — particularly when in-office visits are markedly reduced, the most cost-effective (convenient but with low fees) methods should be flexible.”

Be Proactive with Future Claims

You can improve A/R by scrutinizing the entire process, starting with your practice and going all the way through the end of the billing process. At the beginning of this chain, make sure you verify eligibility and patient demographics to ensure you have no errors — either clerical or via other issues — in your files regarding the patient’s name, insurance number, address, or other problems. You should also verify benefits and collect copays upfront.

Your next step is to electronically submit clean claims within one to two days of services being rendered. As noted above, denials should be worked immediately after posting the remittance. After that, you should develop A/R aging reports to quickly identify potential problems with specific payers.

Why aging reports matter: To determine the value of your receivables, sort the accounts into age groups (30, 60, 90, or 120 days, etc.) so you can focus on the account with the greatest number of days elapsed since payment was due.

Sorting by age is helpful because the older an account, the more difficult collection becomes. For example, an account that is 60 days overdue generally has about a 90 percent chance of being recovered, while an account that is 180 days overdue is likely to have closer to a 30 percent chance of collection.

Know When to Write Off Patient Balances

In some cases, practices may find that they have patient balances sitting around for months without collecting payment on them. When this happens, you have a few options, one of which is to write off the balance. But knowing when that’s the right move can be tricky.

Practices should have a universal protocol for this situation so they always follow the same rules for every patient. Writing off balances should be a last resort, but every office has a different policy on this, depending on the size and the relationship with patients — but you must have some policy. Follow your guidelines with every single person.

Some questions you may want to ask yourself when considering a writeoff policy include whether the patient balance is less than the cost of printing and mailing a statement. Also, ask yourself whether your collection agency has a minimum referred balance, whether the balance is definitely uncollectable, and if the patient is indigent or a hardship case. In addition, investigate whether writing off balances that have been processed to patient responsibility violates any payer contracts.

Ultimately, the decision of whether or not to send a patient to collections is up to your practice, but creating a solid policy that guides you in one direction or another will help you make the decision.