Practice Management Alert

Hint: Coders’ coding choices directly impact payment

If you’re haunted by the claims sitting around unpaid, don’t dally. Summer is the perfect time to catch up on your AR because many providers take vacation, and you can use the [relative] downtime to catch up on backburner paperwork.

Your cashflow depends on your accounts receivable (AR), says Terry Fletcher, BS, CPC, CCC, CEMC, SCP-CA, ACS-CA, CCS-P, CCS, CMSCS, CMCS, CMC, QMGC, QMCRC, owner of Terry Fletcher Consulting Inc. and consultant, auditor, educator, author, and podcaster at Code Cast, in Laguna Niguel, California.

Do Some Fact-Finding First

First thing’s first: You need to know what you’re working with. Know exactly where each category of AR stands: 0-30 days, 30-60 days, 60-90 days, 90-120 days, and even the dreaded 120+ days, she says.

During the pandemic, we’ve had problems accessing our insurance payers, but now that things are returning to normal, we have an easier time accessing them, she says.

The ideal scenario is keeping your physician AR in the 0-30 day category, but you need a process and plan for when it inevitably trends toward the 30-60 day category.

It may be easy to tell yourself that those languishing claims aren’t a priority right now, but that’s dangerous. “That’s a dangerous way to approach claims because your denials will age out,” Fletcher says.

The middle of the road are the claims and denials in the 60-90 day category, and at this point, some of your appeals rights have really passed you by, Fletcher says.

“Look at those contracts,” she says. “Some will only allow you to appeal within 60 days after receiving the payment.”

Top tip: Even if you’re strictly a coder and don’t work for billing or collections, you really are involved in billing, because your coding choices directly affect revenue. “You need to be available to your billers and your collectors should they run into pended claims or processing issues where the codes don’t match, aren’t linked, or that is the reason for the pended claim,” Fletcher says.

Beware the Contracted Rules

Once claims reach the 90-120 day range, you’re passing timely filing deadlines. “Oftentimes insurance companies drop claims in the same batch as others,” Fletcher says. They’ll pay a majority of the claims but miss a few other dates of service, which can be a delay tactic.

“If you continue to ignore those unpaid and nondenial claims — if you don’t catch them, a majority of payers will say you didn’t send the claim to them in time per your contractual agreement,” she warns. “You can try to appeal using your clearinghouse proof of claim sent, but sometimes just the cost of the appeal may not be worth it, based on what you may be paid.”

Insurance companies are sometimes hoping that this is what happens, because it can let them off the hook for payment.

The claims that are older than 120 days are really there to roost, Fletcher says. Don’t let your practice have money that is sitting there, because then you’re looking at a cashflow emergency.

Don’t Lose Track of Patient Balances Either

Patient balances may age out unnecessarily, too, and some insurance carriers are looking at the dollar amounts there and inquiring why practices haven’t pursued that money, Fletcher says.

There are so many options in managing patient balances, Fletcher says. To protect your business, you can institute some practices like keeping a credit card on file and having a policy where patients get a letter warning that their balance will be sent to collections after they receive two statements but don’t produce payment, she recommends. Also incorporate a staff phone call to patients whose balances hold beyond 90 days; they may not understand their obligation to pay, or have some other reason they’re not paying, and you may be able to secure payment right there, over the phone.

Top tip: You need a way to make payments easy and accessible for patients, too, like a secure portal for online payments, rather than accepting only mailed personal checks as payment. An online option like this provides patients access to their clinical information, but the administrative information as well, Fletcher says.

Bottom line: “It’s important to manage your physician AR on a daily basis,” Fletcher says. Instituting rules like this may seem daunting, but your practice will be healthier, financially, and less stressful