subject: Using A Plan To Lower Your Medical Office Insurance Accounts Receivable [print this page] When you take a look at your insurance accounts receivable are you cringing today? It may be higher than usual and that is not uncommon for this day and age. However, now is the time to take control and get it down into those single digit percentages again. Here are some tips to help you do just that:
1. Eligibility is the beginning of your service.
There are many reasons that a claim can go unpaid. The first thing you can do to stop the accounts receivable bleeding in your practice is to begin regularly checking eligibility on each and every patient you see in your medical practice that has insurance. Collecting insurance cards and verifying eligibility of coverage up front is the best indicator of:
* Coverage - verifying coverage dates, limits, co-pays and deductibles
* Subscriber - verifying who is the covered individual
* Priority - verifying which insurance is primary and which one is secondary for filing claims
* Services - verifying if your services are covered
If you are not checking patient's insurance eligibility at the time of service then you are gambling on whether your claims will be paid or not.
2. Utilize your aging reports to work oldest balances first.
It makes perfect sense to attack oldest balances first when working your accounts receivable. However, it is most important to look at the insurance aging report and define which balances are the highest. You want to begin following up on the oldest and the highest balances first. If you see that one insurance in particular has the highest outstanding claims, then work that insurance first. Then work the next plan with the highest balances.
Ultimately, you want to be able to track insurance payments that are being filed electronically within 30 days by following up on rejections and denials immediately after filing. However, many medical offices have not been able to track insurance and it has now aged over 120 days. The sooner you can work a claim the more success you will have, but it does not mean you want to ignore the aged accounts beyond 120 days. For timely filing purposes these are the accounts you want to attack first when working an accounts receivable plan.
3. Refiling and Sending Appeals.
Phone calls could quite frankly slow you down with insurance company claim denials and/or rejections. It is not uncommon to be on hold with an insurance company for the better part of an hour before you have a chance to discuss a claim. If you have access to your clearinghouse rejection reports you can usually tell immediately why a claim has rejected or been denied. Correct and refile claims as soon as possible to get them back to the insurance for review and payment.
Appeal letters for denials will need to be written and sent via certified mail with return receipt if possible to follow the process. If additional operative notes are being requested, those will need to be sent via mail also. For procedures that continually require notes to be sent, begin sending the notes with the original claim to reduce the waiting time for payments.
4. Develop a working tickler system.
You must have a working tickler system to know which claims you have worked, called on or refiled so that you can systematically follow up at the appropriate time. Some practice management systems have built-in collection modules with tickler systems for tracking accounts for review. If you have one, begin using it immediately to keep a record of your communication with the insurance company and also to remind you of which contacts to make next.
It is recommended to utilize your software system to track comments and communication with insurance companies. If you do not have a practice management system to do that then an expandable tickler file will always work to keep you on track of who to follow up with next.
5. Document your processes.
By documenting your process you develop not only a process, but also a collecting procedure to be utilized by anyone who joins your practice in this capacity. Anyone who inquires about your policy on accounts receivable and collecting procedures can readily see you have a process and it is documented. It also makes it very easy for new employees to adapt to your processes if they are clearly written.
6. Recoupment and billing agencies.
If you find that you cannot work your own accounts receivable or do not have the staff to do so, you can always look into recoupment agencies, billing, or collection agencies who will work your outstanding insurance balances for a fee. The fees will vary so you need to investigate these companies to determine which type would best suit your practice needs.
Your accounts receivable does not have to be intimidating anymore. You can achieve the percentage goal that you desire once you put a plan in place. Just remember that it will not correct itself and you must make a practice manager decision to take charge of it now.
by: Rebecca Morehead
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