Healthcare regulation changes and increasing enrollment in high-deductible health plans impact the financial health of physician practices and health systems. Simplifying the payment collections process can help healthcare organizations reduce bad debt and increase profitability. Consider the following three key areas to ensure efficient and accurate reimbursement at your practice.
Increase point-of-service patient collections
You can save a lot of time and money by informing patients that they will be responsible for a deductible and/or coinsurance payment ahead of their visit. Ensuring that you have a workflow in place to collect amounts due from patients at the time of service reduces accounts receivables and improves patient satisfaction. To help patients pay, you can use cost-of-care estimation tools to deliver accurate patient estimates as early as possible. Front-end office staff can also check with insurance carriers on the eligibility and benefits of patients prior to patient visits. Setting patient financial expectations upfront and helping them understand their benefits reduces bad debt associated with write-offs of patient balances.
You can encourage patients to pay through your patient portal as well and offer financial counseling or information about any available payment plans. Making it easier for patients to pay promotes a healthy relationship and ensures patients choose your practice again for their healthcare needs.
Lower denial rate
Insurance claim denials are a challenge for many billing departments—one study found that 9% of charges or ($262 billion) were initially denied in 2016 and it cost providers approximately $118 per claim to appeal denials. To reduce your denial rate, ensure your claims are clean before they go out the door. Hiring a certified professional coder can help get your claim accepted on the first submission. An outsourced revenue cycle management company can also educate physicians on the correct codes to use to avoid claim rejections from payers.
Claims-scrubbing software can also be used to get rid of mistakes that result in denied or underpaid insurance claims. It’s best to look for claims scrubbers that achieve over 95% claim acceptance on the first pass.
Reduce days in accounts receivable
Minimizing days in A/R and claim denials are key to maximizing your revenue. If your number of days in A/R is greater than 40, then you may want to consider improving this number. To lower days in accounts receivable, implement a workflow where your staff post charges on a daily basis, work on denials daily, and follow up with payers each time a claim is submitted. This ensures that you get more money faster, increasing your cash flow. It’s also best to aim for your percentage of days in A/R greater than 120 days to be no more than 20%. Be sure to work with your billing team to address receivables that are over 120 days so that you can recover amounts from these accounts.