Today’s health care providers face an onslaught of new rules —including complex coding requirements, privacy concerns, higher copays, unpaid debts, and denied claims, to name a few—making it more important than ever for medical offices to create clear medical billing policies.
Establishing a comprehensive written set of policies and procedures—and training staff to use it effectively—can help with accounts receivable management and provide consistency among the billing staff.
Experts seem to agree that there are at least eight steps that are fundamental in this process: 1) registration. 2) Establishment of financial responsibility. 3) Check-in/check-out. 4) Coding/billing compliance. 5) Preparing and transmitting claims. 6) Adjudication. 7) Generating bills. 8) Assigning payments/arranging collections.
The aforementioned pressures have led to the development of a number of best practices that help medical offices streamline billing from start to finish as well as save time, money and frustration. Some of those best practices are the following:
Collect Co-Payments At Registration
First thing’s first: The best way to secure co-payments is to require it in full as part of the registration process. Post a sign at the front desk and train the receptionist to review insurance cards and collect the appropriate payment. Health care is increasingly seeing cost burdens shifted to the patient. Staff needs to be aware of these changes and confirm the proper amount is collected, every time.
Train (and Retrain) Coders
Never has medical coding been so complex and never has the risk for underpayment due to coding errors been so high. It is essential that medical billing clerks are trained and certified before they start work. And the more specific the training, the better. An effective billing policy must, therefore, include clear training standards for new hires and incorporate regular retraining sessions. Medical associations, insurance companies, and hospitals offer educational resources and classes. Monitor common errors and denial claims as well as review them regularly with the billing staff.
Forms of Payment
It’s a fact: we live in an increasingly cashless (and checkless) world. The more different kinds of payment you accept, the more customers you can process. At the same time, mobile payment options like Square, Google Wallet, and Apple Pay have streamlined transactions even further. What’s more, security improves by the day. Nevertheless, like all vendors, you’ll need to look out for identity theft so a fraud detection protocol should be part of the collections policy. Keep an active credit card on file to expedite payment. Utilize technology (electronic remittance, claims status, insurance confirmation) to increase efficiency and payment.
Rule for Non-Payment
It’s inevitable, especially in a time of increasing health costs, some customers will be unable to pay. As difficult as it is to turn patients away, carrying a balance for them is not sustainable. Set a maximum limit for non-payment (anywhere from $150-$250 is typical). Make it clear upfront that there will be late fee charges and that accounts will be turned over to a collection agency after a set period of time.
Last Resort: Collection Agency
Unfortunately, there will be occasions when a collection agency becomes necessary to retrieve debts. Adherence to the collection practices listed above should help limit these instances, but the billing policy should include a clear system for debt collection when all else fails. Set clear deadlines so your staff doesn’t have to make individual decisions. Not all collection services are created equally. Find one that is experienced in healthcare collections and the relevant privacy laws. Do your homework, conduct interviews, check references, and choose carefully. The fee charged for collections can vary widely and the cost of using an agency should always be compared against exhausting all in-house options.