AR in a medical practice is the most difficult part of the Revenue Cycle, and most offices fail in collecting it. Your typical practice does not have the budget to hire the staff needed to work their AR, and Insurance companies count on this. AR is probably the most tedious part of the billing process and without a trained staff who can dedicate their day to collecting the AR, it is impossible to collect what is owed to you.
Billing companies and employees where you entrust your billing should be well trained and willing to do what it takes to get paid. Do not think that you can have your office manager perform your billing and still run your office, it takes more than one person to handle your billing and if you try to just get by, then you will lose money.
7 Step AR Recovery Process:
1. VERIFY PATIENT INSURANCE ELIGIBILITY (this and accurate demographics are a must for collecting Insurance and Patient AR)
2. Evaluate Insurance Contracts to ensure they adhere to current CPT guidelines.
3. Adjust your charges with a consistent formula based on a percentage of Medicare. (This allows for an accurate gross and net collection percentage)
4. Scrub your claim and use a coder with knowledge of your specialty.
5. Submit claim electronically to decrease the life cycle of claim.
6. Do not wait to receive something in the mail, call when the claim is older than the contract allows. (Medicare 20 days, BCBS and other commercial carriers is usually 30 days)
7. BE PERSISTENT and don’t let them get away without paying you.
Insurance billing is not as easy as you used to be and is important that you realize this. Everyone wishes that the days of billing and getting paid were still here, but they aren’t and is important that you change with the times. Electronic Billing, new practice management software, Electronic Medical Records, and sufficient staff are all ways to drastically improve your billing efficiency.