Ensuring Insurance Payments the Old-Fashioned Way: Hard Work

I t might seem that it's a third-party payer's job to make sure your office is paid. More likely, it might even seem as if it's their job to get in the way of you being paid. The truth is. though, that it's your job to make sure you arc paid if you have elected to accept assignment on behalf of your patient. Of course, you can and should get help from that patient, but its a collection of systems that begins with the very first new patient call. Whether your financial department consists of three people, an army of bill-crs and collectors, or your part-time at­tention on the days you don't work at the front desk, the system of running the de­partment should be the same. Regardless of the size of your practice, billing must go out. insurance companies must be called, and payments must be processed. Just as an episode of care, billing and collections arc a process with a beginning, middle, and end. The beginning of the finan­cial relationship is the patient's first contact with the practice: the end of the process is a zero balance. It all sounds simple written out like that, doesn't it? So why. all too often, docs it feel so messy and out of control? The answer is systems and procedures. If you don't have them in place, with realistic and dedicated blocks of time set aside specifi­cally for each part of the process, then you arc constantly in reactive mode, running from task to task, and haphazardly and frantically trying to put out fires. Docs someone—maybe even you—on your team rush around like Alice in Wonder­land's White Rabbit ("I'm going to be late. I'm going to be late. No time, no time!")? Allow me to offer an alternative perspec­tive. Yes. that live patient in front of you is your first priority: a new patient phone call might be next. But if you've done the math on how much time you need to spend on administrative duties (let's say it's ten hours a week), it's actually a simple matter to plan for those tasks ahead of time and schedule them. Sure, things will occasionally come up that you can"t ignore, but as much as possible, consider admin time as sacrosanct as the time you spend with patients. Take an hour a day and let the calls go to voiccmail. I promise that you won't lose a significant number of patients doing this, especially with a well-worded outgoing message that explains why you're taking time to tend to business and when precisely you will return the call. Tracking your time can be as simple as a calendar with blocks marked off for specific duties and a timer. When the timer goes off after an hour. 30 minutes, or whatever time you set, wind up and put those tasks aside in a systematic, organized way. secure in the know ledge that you—or anyone else—can pick up where you left off the next time admin duties arc blocked off within vour schedule. So what will you be doing during this time to make sure the practice is paid? NEW PATIENT PHONE CALLS: Of course, these calls can't be scheduled, but recognize that they launch tlic billing and collection process, and work best when you have a template or script. Does the patient have third-party coverage with which you can assist them? Is tliis a workers comp situation? Capture uiat data—in writing—right now. and save it for the next step, which you" 11 do at the designated time. Don"t fall for thinking you have to rush into the next step (insur­ance verification) immediately after each patient phone call. INSURANCE VERIFICATION: Because worker's comp. Medicare, major medical, personal injury cases, etc. all have individual requirements, consider having different forms for each type of verification of coverage. Make sure uiat you thoroughly identify the medical re­view policy for the relevant carrier. There canbc surprises here: for example, you might discoverthat massage lias to be done bv the DC in order to be covered. FINANCIAL DATA CHARTING: Once insurance and its poli­cies have been verified, the back-of-thc-housc information needs to be entered, including date of accident (if applicable): who tlic insured is if not the patient: getting a copy of photo ID and insur­ance card: and determining whether this is a new visit, a return visit, reactivation of care, or a new incident. Everything should be in writing so that this file—the beginning of a patient file and routing slip—belongs to the practice and doesn't just live in one person's head. This ensures a clean claim will go out. CHARGE ENTRY AND COLLECTION: If you use a rout­ing slip that travels with the patient throughout the practice—from doctor to therapy CA to massage therapist to product purcliascs and back to the front desk—staff can use tliat document to make sure all charges are entered correctly and nothing is missed. Of course, you'll want to enter cliarges correcth. or you're not going to be paid correctly. That means know ing and using the proper codes and modifiers, and making sure there is clear communication from tlic doctor about the exact diagnosis and treatment. These routing slips are invaluable for end-of-day balancing. BILLING: Everything hinges on a clean claim. If you've done a goodjob of financial data cliarting. entering tlic codes correctly with the proper modifiers and feel you haven't missed a tiling, do yourself and the practice a huge favor, and assume tliat maybe you have. Take the process through "claims scnibbing." either electronically or with your very own eyeballs. Make sure it looks right and that nothing jumps out as a red flag. Finally, make sure you review yesterday's edit report to ensure that whatever didn't go out yesterday will indeed go out today. From a compliance perspective, you'll also want to review those edit reports look­ing for patterns of mistakes or confusion: cither should trigger further training or retraining. RECEIVING AND POSTING PAYMENTS: This sounds simple, but it's amazing how often this is overlooked. Have a set system for opening the mail, and sort it into four categories: Mail to go to the doctor This could be anything from the electric bill to Sports Illustrated. Checks orothcr items to be posted: Might be a check (y ay!) or it might be a zero payment or some tiling to be applied to a deductible. Items that need a phone call to resolve: Maybe the in­ surance company paid bill number three but not previous bills one and two: maybe the insurance company says the patient's coverage lias been terminated: or maybe a claim was. you believe, inappropriately denied. Don't stop and do this right now. Save it for your designated follow-up time! Items that need action to resolve: Perhaps someone at the front desk forgot to attach office notes to a bill that went out and it will be as simple as attaching and rcsubmitting. Again, set this aside fora future follow-up. Now. dclivcrthcsc stacks to the right locations and continue with your payment post­ ing. Any additional findings while posting will be added to the appropriate follow-up location. REACTIVE FOLLOW-UP: By now. you should havcorga- nized those groups of mail, and anything requiring a phone call is slated fora follow-up. Usually generated from the mail or a payment posting, this could be a denial that doesn't make sense, a payment that was just plain wrong, or something left off the bill, among other tilings. Do not simply rcsubmit the bill: it will likely come back with the exact same outcome. Take the appropriate allotted time to make phone calls. Get specific in your questions: "I am unclear on why this was denied, can you help me? When I can I expect a check?" And. finally, especially if you'rc dealing with outsourced insurance adjusters whose accents you can't understand or who can't understand you. don't be afraid to ask to speak to a supervisor, but do it kindly: "I'm sorry we're having difficulty communicat­ing. May I please speak to your supervisor?" Keep detailed notes in the account and use your tickler to remind you when next actions are required. PROACTIVE FOLLOW-UP: This is based off your aging report, and failure to keep up with this is the single biggest killer of cash flow. It's a great choice to print out your aging report with the highest balances at the top. so you can spend your time on the most money owed. It's also not a bad idea to print out aging reports by type orcarricr. so. forexamplc. you can spend an hour going through all the Medicare issues at once. As you follow up. make exhaustive notes in the patient's account and tidbits right on the aging report. Make sure credits are applied properly, reconcile with the patients" files, and make a big check mark when something is complete. Clean up as you go. TICKLER FOLLOW-UP: Essentially, this is your re­minder system. It's easy to implement—and so often overlooked! Whether you do it electronically or with note cards, use card divid­ers numbered 1 through 31 for the days of the calendar and put tickler reminders behind the appropriate dates. If this insurance company says you'll have a check by December 17. when you get to number 17 for that month, all you have to do is look in your file in order to know tliat you need to confirm payment or get back on the phone and find out win it isn't there yet. It's simple—check it daily, complete the actions noted, or move it forward a day if time didn't allow for completion. APPEALS AND RECONCILIATIONS: When you get a denial because the third-party payer doesn't deem the sen ice to be "medically necessary." you appeal it—every time. Other­wise, you're setting yourself and die practice up for an ongoing admission of incorrect documentation and coding. This isn't a one-person job. by the way. Tlic practice should have built-in ac­count ability procedures tliat doublcchcck follow-ups, aging, collections, and resubmissions to make sure nothing is stuck in the system. In a dysfunctional office, tilings tend to become stuck at the same places, repeatedly. This may all sound well and good if you already have some systems in place, but what if you just have a mess on your desk and no perceived time in which to tackle it? Actually, the same steps as above apply. Sort it all out. Decide wliat needs action, what needs a call, what needs a different kind of follow-up, and what could be tossed. As you go. create the systems you want in place so tliat you never have to wade through such a mess again. I've seen repeatedly tliat in a busy or understaffed practice, billing and collections is often the first tiling to fall off the radar screen. Of course, patient acquisition is paramount: without patients, there can be no practice. But consider tliat without a strong system of billing and collections in place, what you"vc got isn't actually a chiropractic practice at all—it's a free clinic. I don't know about you. but while I am all for community sen ice. your office certainly lias bills to pay and you like to be reimbursed for what you do. If you agree, start putting payment collection on par with sen ing your patients. You can't rcallv have one without the other. Kathy Mills Chang is a Certified Medical Compli­ance Specialist (MCS-P) and. since 19H3, has been providing chiropractors with reimbursement and compliance training, advice and tools to improve the financial performance of their practices. Kathy is known as one of our profession s foremost experts on Medicare andean be reached at (855) TEAMKMC or info'skmcuniversily.com