Persistence, organization help get accounts received

A column about keeping your practice in good health

By Mike Norbutcovered practice management issues during 2002-06. Posted June 27, 2005.

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It can be pretty depressing to scan your accounts receivable, adding the numbers up and feeling helpless as they seem to just float farther away.

Thirty days. Sixty days. Ninety days. Pretty soon, your accounts are more than 120 or even 180 days old, and all you can do is write them off as uncollectible.

But your accounts receivable don't have to be an income graveyard, health care consultants said. Organization and persistence can go a long way to helping you capture some of that revenue and making sure your AR doesn't translate into RIP.

Most physicians delegate billing and coding issues to staff, but that doesn't mean you should remove yourself completely from the picture, consultants said. Accounts receivable statements can tell you a lot about your practice, and improvements in collection techniques can be a financial advantage.

"The physician has to care," said Allan DeKaye, president and CEO of DeKaye Consulting Inc., in Oceanside, N.Y. "If they're not going to care about it, who is?"

Consistent tracking and calendar benchmarks are the first steps toward taking a proactive approach with your accounts receivable. Most insurers will have a fairly common reimbursement schedule, and billing software generally allows you to analyze claims and payments by company.

For example, if you know your local BlueCross BlueShield HMO pays claims within a few weeks, and you have claims that have been outstanding for 60 days, it's worth investigating, consultants said.

Carefully tracking claims can help protect future income as well. The sooner you learn that a claim has been denied, you can pinpoint the reason for it and correct it, rather than submitting dozens of other claims in the same fashion without realizing you won't be paid for them.

"If we get a denial, we post it separately and analyze it at the end of the month," said David Weiss, director of physician services for Henry County Health Center in Mount Pleasant, Iowa, and administrator for Family Medicine of Mount Pleasant, a 14-physician primary care group.

"We figure out why we got the denial, where we didn't follow their rule. Then, we revise our policies."

Sometimes, an insurer's denial can be for something as simple as incorrect patient information, DeKaye said. Staff members need to double-check the data they enter, because if a name or address is recorded incorrectly, it could lead to delays and denials, he said.

Individual delayed claims should be fairly easy to spot if you track charges to each insurer, but it's the systemic delays, such as one insurer constantly denying claims, that can wreak havoc on your accounts receivable. Physicians around the country have been fighting managed care companies in court over delayed or downcoded payments, but if you're a small fish with few resources, the onus is on you to make it as easy as possible for insurers to pay you, experts say.

Don Wagoner, MD, a family physician in Burlington, Ind., said he meets weekly with the office manager and chief coding officer to analyze income reports and accounts receivable statements for his five-physician practice.

Charges and collections are usually consistent enough from week to week to make it easy to spot when income is lagging, he said.

Dr. Wagoner said collecting from patients is becoming increasingly important as well, as managed care companies shift more of the burden onto individuals' shoulders. His office has made more of an effort to collect co-pays and deductibles up front, and staff members know who the cash-paying patients are, he said.

"We can identify the ones with no insurance right up front, and they know when they come in that they'll be expected to pay or set up some sort of payment plan," Dr. Wagoner said. "We'll discount it if they pay cash."

Discounts can provide incentives to pay the bill in full, which means the practice collects at least some revenue from the visit. That's better than sending out bills and having them go unpaid, which inflates the accounts receivable and forces a practice to consider sending certain accounts to collection agencies.

Weiss said at his practice, the billing staff reviews the appointment schedule ahead of time and contacts the patients who are on a self-pay plan to remind them they will need to pay for service that day.

"We try to work with them prior to the service or at that time," he said.

Your accounts receivable may be higher than it should be because of your fee schedule, Weiss said. Often physicians don't knowing exactly how much an insurer will pay.

Any amount you charge above the reimbursement rate will fall into accounts receivable, with virtually no hope of being collected. Suddenly, you find you're collecting less than half of what's in the account, when in reality, your collection level could be higher if you could match your charges more closely to payments, Weiss said.

"Make sure your fees are based on sound principles," Weiss said. "You should know your fees have a statistical basis. What are your insurance companies reimbursing you?"

Mike Norbut covered practice management issues during 2002-06.

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