Medicare Compliance & Reimbursement

Keep track of your Accounts Receivable to preserve your financial livelihood.

Now, that you’ve mastered all that CMS and the healthcare industry have thrown at you this past year from MACRA to the HIPAA audits to the end of the ICD-10 grace period — it’s time to get a handle on your practice’s revenue cycle issues. If you’re losing money left and right, it might be a red flag that your Accounts Receivable (A/R) policies need a 2017 overhaul.

A/R defined: A/R is the money that is owed to the practice. If you aren’t aware of what your A/R looks like at any given time, you are overlooking an important piece of the collections puzzle. Follow these 10 best practices to set your practice on an improved A/R track and avoid thousands in lost reimbursement.

1. Sign, Seal, and Update Before Check-in. Reach out to your patient via secured text and email or lob a call before the appointment to ensure she is authorized prior to rendering service. “The expansion of Medicaid to managed care, as well as the proliferation of Medicare Advantage plans now require prior authorizations for many services rendered,” says Vinod Gidwani, founder of Currence Physician Solutions in Skokie, Ill.

2. Meet and Greet But Also Educate Patients. Your front desk staff must be savvy, and the first step in managing your assets is getting patient details upfront. “Once the patient is at your office, collect any copay and coinsurance, and then educate the patient on her out-of-pocket expenses that may accrue,” recommends Raymond Kelley, vice president of operations with Bristol Healthcare Services, a medical billing and coding company with offices in Cerritos, Calif. and Chennai, India. This step is essential to ensuring that if the patient gets a bill down the line, she won’t be shocked since you already explained the potential payments beforehand.

3. Be Timely with Patient Statements. Sitting on statements, so you can bulk them together sounds like a good idea. But, waiting too long to send out the bill can confuse the patient, who may not remember the exact nature of the charges. Once you get the insurance payment and remittance advice, send the patient a bill for any applicable balance right away, Kelley advises.

4. Alert Patients About Pending Balances Ahead of Time. Don’t be shy about telling your patients that they have account balances before they come in for another visit. Make it part of your practice policy that charges must be settled to receive future services. Appointment follow-up calls are a great venue for notifying a patient about an account balance.

5. Don’t Leave Untimely Claims in the System. “You should review all claims and if any are delayed or in appeals, set them aside,” says Keith O. Tobin of Medorizon, an Illinois-based medical billing and collections firm. This will allow you to address those issues directly rather than just leaving them in the pipeline with the paid claims.

6. Keep Track of Claims Through the Review Process. A successful claims system allows you to follow the path that your claims take from start to finish. That way, you can hone in on a discrepancy and always know where it is, as well as know what the next steps are to rectify it.

7. Run Reports Periodically. Set a schedule when you’ll run reports to identify unpaid claims in the system. “Utilize both activity reports and claim date reports to ensure all claims are worked,” Tobin says. You can even configure the reports to run from the oldest date of service to the newest, or you can group them by payer to see where you’re recouping the most and the least reimbursement.

8. Master the Payer Guidelines. If you don’t understand the specific payer guidelines, documentation requirements and reconsideration/appeals process, you will have a tough time recouping those more stubborn payments, particularly with Medicare. Make sure you and your staff are in the loop as policies evolve, especially now with the Quality Payment Program under MACRA. It’s a good idea to check monthly with your MAC to ensure you are spot on with your claims, forms, and compliance.

9. Closeout Accounts at the End of the Month. Loose ends are the harbinger of disaster in A/R. Always post payments on time to patient accounts and perform a month-end closeout, Kelley advises. That way, you are always timely in letting the patient know his balance. If you fall behind, then the whole system falls apart.

10. Make Collections a Priority. You will need to work on a situational basis to see how many chances you can give a patient to pay up his pending bills. If you make contact with patients and they promise to pay, keep sending up-to-date invoices as long as they are responsive, advises Alice Scott, co-founder of Solutions Medical Billing in Rome, N.Y. If, however, you never hear from the patient, only make three attempts to collect before sending the bill to a collection agency, recommends Scott.

Endnote. This year, many EHR vendors have updated their comprehensive Revenue Cycle Management (RCM) programs to include MACRA policies, and they can help you pinpoint claims issues, generate periodic reports to keep you abreast of problems, inform patients of unpaid balances, and more. Check with your business partners, billings team, and administrative staff to ensure you’re all on the same page in regard to A/R and current claims regulations.