Does your office collect the right amount during a patients visit?

A recent survey released on June 15th, 2009 by NaviNet Inc., found that 49% of practices were unable to estimate the correct amount due at the time of visit, other then predetermined co-pay.

As a result a result according to McKinsey & Co. doctors collect only about half of the balance due from patients.

What practices don’t understand is that collecting at the time of service is one of the things that must be done, the way things are even insured patients are increasingly on the hook for an even-larger share of costs.

In 2008 the avarage patient deductible grew by about 10%. On 2009 the deductible grew by about 15%. This becomes a big loss in revenue and must be collected at time of service.

Proper front desk training and review must be done once a month.

- Confirming the patient’s eligibility coverage and benefits, must be done before patient is seen.

- Providing accurate estimates of patient out-of-pocket expenses for specific services.

- Explaining to the patient, why they are being charged for these services.

- Helping patients that cannot afford to pay the amount if full, by setting up an automated payment plan.

- Allowing the patient a call to speak with their insurance carrier regarding their benefits.

Keep in mind the best practice is to collect the money  that are owed from patients at time of service, before they leave the office.

Practice owners know that most returned insurance claims often become Unpaid Insurance Claims.

Carriers deny claims for just any old reason now days!

You need a professional to deal with the insurance claims, someone that is willing to spend time to go after the rejected claims and get you results.

Most of the time the problem is in-house. Too busy to correct and resubmit the claim, not that a devoted staff member ignores the returned claim, but puts the claim aside hoping it will go away. After all there is work involved to resubmit the claim and keep an eye on it.

Some of the older providers, or their managers, may be afraid of change when it comes to electronic billing and using a billing service. They may be set in their ways, and don’t want to change, until the day comes when they realize they aren’t collecting as much as they could/should be. You don’t see the problem until you look for it, or until someone points it out.

Some of the providers that are starting out may think they don’t have enough volume to justify using an outside service. This is not true, a new provider would be wise to use an outside service, rather then pay an employee.

New regulations have changed the way we submit claims to all government carriers, and there are more changes on the way.

There are two simple ways medical practices make money. The source is Insurance and the Patient.

“Some doctors spend more time filling out forms than taking care of patients.” – Dr. C. Everette Koop, former Surgeon General.

          When filing claims using paper forms, you are decreasing your cash flow, anyone can see that.

 Turn around time can take up to 60 days, if you ever get paid.

-There is a very high rejection rate. The National rejection rate is about 35%.

-The cost of the average paper claim is about $12 – American Medical Association Survey

          Given the new electronic Claim Submission System and using a Billing Service you can easily increase your cash flow and productivity.

-Average rejection rate from a billing service with well trained staff is under 3%.

-Your billing costs in some cases can be lowered by 50%.

-You would see faster payment of claims. The Average is 14 to 20 days in most cases.

          I am not saying that you can’t achieve the same results in-house, given above average paid billing staff, with proper training, the right support staff and up to date hardware and software. Don’t forget, you will need a dedicated manager to keep an eye on it all.

Yes, there is an initial investment and time needed, to set up proper in-house billing system, but it can be done.

          Your other option is to let the professionals handle it, in most cases they have everything setup and most billing services are well motivated, because they don’t get paid, if you don’t get paid.

I am sure you can think of ways to increase your bottom line, when your staff can concentrate on other aspects of the business and you have extra space to work with, when you are no longer doing your own billing.

What a relief!

Posted by a Practice Management Consultant at Real Practice Solutions, LLC. in New York.

We specialize in making your practice work more efficiently and more profitably.
http://www.realpracticesolutions.com