Here’s a silly question for you… do you like getting paid for your work?
Of course, you do! Who in the world would say “No” to that?
Turns out though, getting paid is not always as easy as you might think.
Why is that?
Part of the reason is the dual, complicated landscape of medical billing. To bill for services, most practices bill not one, but two parties. They must bill insurance companies and then patients.
And to complicate things even further, frequently patients may be billed only after insurance billing is complete.
A Unique Arrangement
Unfortunately, this arrangement rarely works in your favor.
Sure, it’s not a problem when claims get paid on time. As soon as you receive reimbursement from insurance, you bill patients for the outstanding balance.
But it’s a different story when there’s a problem with the reimbursement.
Because anytime claims have to be corrected, resubmitted, or the insurance is waiting on additional information, you have to wait for your money. Additionally, you have to wait before you can bill patients.
But here’s the thing. It’s been shown the more time elapses between the service provided and the time it gets billed, the less chance of collecting on the outstanding balance.
Of course, you want to make sure that coding and billing are correct before claims are submitted.
Best case scenario, there would be no reasons to recode or resubmit a claim. Ever!
But we all know that’s not how it works.
Claims may need to be corrected or resubmitted for any number of reasons. And it’s not always because the practice made a mistake or omitted a piece of critical information.
Sometimes patients, unintentionally provide inaccurate information. Data may get entered incorrectly into the system, or the insurance company could make a mistake.
That’s why it’s in your best interest not to leave anything to chance!
Your Front Desk
So, what can you do to safeguard against problems?
Unfortunately, I don’t think you can guard against them 100% of the time. However, there are a few simple steps you can take to help minimize billing issues from the start.
You see billing, is only one side of the coin; the other is what happens at your front desk.
Frequently, problems with billing and collections start at the front desk. Incidentally, that is where many offices make mistakes.
However, your front desk is your most significant leverage point, when it comes to billing and collections.
That’s where it all begins!
The entire process starts with collecting up-to-date and correct patient data, that gets submitted to insurance down the line. But if the data is outdated or incorrect, you’ll be fighting an uphill battle from the start.
Every day we read through questions and comments from our readers, many about billing.
Here’s are just some of them:
- Should I bill patients or collect balances when they’re in the office?
- What can I do to collect an open balance after a patient has transferred out?
- How can I encourage patients to pay their responsibility, without being pushy?
- What can I do to keep claims from getting rejected?
- My billing company is not working out; what are my options?
Over time we’ve noticed some offices have a problem with collecting payments at their front desk. Additionally, some run into problems because they don’t capture correct information and cannot submit the right data to insurance.
But if you want to stay in practice, you must get these two things right. You must bring in enough money to keep your doors open!
Here is a list of the most common billing mistakes we’ve come across, complete with suggestions on how to avoid them. Note that most mistakes occur no matter if billing is done in the office or outsourced to a billing company.
Mistakes with insurance:
Not obtaining up-to-date insurance information at every visit
Collecting up-to-date and correct insurance data is critical to your financial success. Take the time to create systems for your front-desk that ensure accurate insurance information gets collected every time.
Not verifying insurance coverage before the appointment
Train your staff to check insurance coverage the night before an appointment, or the morning of. Create a policy, so your team knows what to do in case someone does not have current insurance but demands to be seen.
Failure to question or asking insurance for review of a claim
Many don’t challenge the decision made by insurance when denying a claim or giving a determination that works against the patient and you. It never hurts to question why a decision was made and to ask for another level of review if you have a strong case.
Not following up on rejected and denied claims promptly
If your billing is done in office, make it a priority for your staff (or yourself) to follow up on rejected and denied claims as soon as possible. If you wait too long, you might miss the timely filing window and not get reimbursed for the service.
Failure to review reports
No matter if you do your own billing or if someone else does it for you, always ask for and review the reports. If you’re using software, get familiar with the type of reporting available to you and determine which are meaningful for you. Watch them for trends!.
Mistakes with billing company:
Not requesting and reviewing billing reports
This is similar to the item above. Don’t make the mistake and rely on the billing company to point everything out to you. Find out what reports are available. Regularly request these reports and review them. Again, watch for trends and red flags!
Not questioning the billing company when spotting red flags
If you notice something unusual or a developing trend, ask your billing company for an explanation. Are they billing and providing follow-up per your agreement?
Waiting too long to address problems
If you become aware of issues, don’t wait too long to talk to the billing company. Keep in mind, you are not their only client, and they are busy. Talk with them as soon as possible, giving them the benefit of the doubt. However, if things do not improve don’t hesitate to look for a company that may be a better fit for you.
Extending too much trust
Don’t trust blindly; this includes your office staff and billing company. Learn and understand the fundamentals of billing. If you do, you can determine the effectiveness of the billing company, review the reports you receive, and can to an informed decision.
Mistakes at the front desk:
No system for complete and accurate collection of patient data
Your office must collect complete and correct data, every time. Build systems in your office, so your staff knows what to collect and how to do it, consistently. Train your staff properly!
Lack of clear financial policy
Having a clear financial policy is a must. Not only is it helpful for you and your staff, but it also lets patients know what is expected of them. Apply your policy across the board, to all patients.
Not collecting copays at the time of service
It’s easy to forget about copays or to let someone slide by if they don’t have the money. However, doing so will cost your practice large sums of money over time. Again, put systems in place that ensure copays are collected at the time of service, every time.
Not collecting coinsurance and deductibles when due
A clear financial policy should minimize these problems. I suggest you train your staff on how to handle various scenarios; for example, if a patient refuses to pay or cannot pay, yet demands to be seen.
Not offering payment options to patients
Investigate signing up with one or two payment services. You’re helping your patients keep up with their payments when you can extend different payment options to them.
Front desk staff uncomfortable with the “Money Conversation”
You may want to have a talk with your staff (or perhaps with yourself). Many of us are uncomfortable talking about money, and even more asking for it! But this gets in the way of success at the front desk! Talk to your staff, have them role play using scripts, and brainstorm “What If” solution.
Your greatest leverage point is at your front desk. Remember, many times you don’t get a second chance.
Make every effort to capture correct and complete information from patients. It allows you to bill for your services and get reimbursed without needless delays.
Make it clear to patients that copays and balances are due at time of service. Establish clear financial policies and enforce them across the board.
Train your staff, so they are comfortable asking for both, information and money. If you work by yourself, get comfortable with having the “money talk.”
We want to know what you think; share your experiences with us. Please leave your comment below.
By Johanna Hofmann, MBA, LAc; regular contributor to the NPBusiness blog and author of “Smart Business Planning for Clinicians.”
Thank you, once again, NP Business for your timely and informative blog. As a solo NP Family Medicine practitioner, we have systems in place to do everything that you detailed, including a written Payment Policy detailing the patients’ cost sharing terms and conditions. Great! We have it all in place.
Our biggest concern is understanding the Eligibility Reports that we do get electronically from the insurers. Knowing when that patient’s outstanding deductible means the patient 1. needs to pay it before the insurer pays – meaning after claim settlement the patient owes us directly an outstanding balance which should have been collected at the time of service, or 2. if the insurer pays the claim and the paid amounts are deducted from the patient’s Yearly Deductible and the patient only pays the co-pay or the co-insurance portion?
I hate the “surprise” of not having collected that “deductible” amount and only collected a measly “co-payment” which leaves the patient confused and owing a larger balance and my practice with a long gap in cash flow!! Lucky for us, I do stay on top of the claims, and I make adjustments to the patient’s records immediately. Also, we are fortunate to have a small but growing patient A/R. No matter how small, those outstanding monies are not serving the best interest of my practice.
Where are the resources to help practices better understand that Eligibility info.? As you know, it is time prohibitive to “call” every insurer for each new patient when there’s this pseudo-electronic version available. I hesitate to implement programs to really grow the business until this issue is better under control. TIA.
Thank you, very informative article.
Hi Jennifer, that’s a great question.
Eligibility reports can vary with payer (I know, they do not make it simple). It might be a good idea to make a call to the provider rep and ask them to explain it to you.
In the meantime, gather up some examples and bring them to the next NPBO™ Members meeting and we can spend some time discussing and dissecting the report.
Thanks for stopping by Nancy.