Medical practices cannot conduct business in today’s market like they have in the past. Medical costs are soaring, and reimbursement is not increasing at a rate to offset expenses. It is vital that we have a pulse on our revenue cycle to ensure timely and accurate reimbursements.
What you could lose
There are many cycles a claim undergoes prior to being paid. To identify trends and opportunities within the practice, it is important the claims process be monitored. Failure to monitor this process will result in a loss of revenue.
How to monitor the claims process
- Claim Submission – To reduce claim denials, a timely and accurate submission of claims is key. A certified coder should review the progress note prior to claim submission to ensure documentation supports the services being billed to the payer. The entire claim should be reviewed to determine if modifiers are needed and for diagnosis accuracy.
- Payment Posting – Determine if there is an opportunity to receive electronic payments by reviewing payers currently posting manually. Payments should also be reviewed to ensure appropriate insurance payment is being received.
- Insurance Follow up – Ensure staff is working denied claims in a timely manner. Staff should not just be rebilling claims but reviewing denials and payer websites to make necessary corrections, so the claim is not denied again.
- Patient Payment Follow up – Review outstanding patient balances. When patients arrive for appointments, collect outstanding balances and copays for the day’s visit. After three statements are sent, call patients regarding their unpaid balances. Attempt to collect payment in full or set up a payment arrangement with the patient.