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Revenue Cycle Management: Maximizing Your Reimbursement (Part 2 of 2)

In the first part of our series, we discussed how to set up your Revenue Cycle Management (RCM) and the role certain areas of your practice (other than billing) play in the process. Training your staff to understand their part in RCM and communicating expectations with your patients is essential to eliminating barriers when achieving a financially successful practice.

At this point, we will now explore the billing and follow-up components to Revenue Cycle Management in order to maximize your reimbursement…

Strategic Bill Planning and Management

Whether your practice employs an onsite billing staff or depends on an outside billing firm, strategic planning and oversight are essential. Key areas include:

  • Transparency
  • Biller’s notes
  • Claim verification
  • Knowing your billing cycle plan
  • Developing a payment plan
  • Collecting balances (via your front desk or a collection agency)
  • Discharging patients in collections

If you are using an outside billing company, you must be able to access the system they are billing from. There are two options to choose from:

Option 1 – They are using your system

Option 2 – You have access to their system and can log in as desired

Assure you are receiving monthly reports from the billers/billing company. Each time a biller touches a claim or an account, there should be a note made in the PM system. A great rule of thumb: The billing notes should be as good as the chart documentation. Anyone should be able to walk through the claim and follow up just by using the notes made into the system.

Monthly reports are not enough to fully manage the billing area, however, leaving the practice vulnerable to key areas. Assure the billing team separates “adjustments” (contractual reductions for fee schedules) and “write-offs” (uncollectible moneys). Add into your agreement that the office must approve all write-offs.

Communicate the expectations of all claim information, follow up and document patient conversations directly into the system. Management and front desk staff should be able to look at an account and have a good understanding of where things stand without having to ask your billers.

The deadline for an insurance company to receive a claim varies widely. Medicare is one whole year, whereas some insurance companies consider timely filing to be 60 days from the date of service. (Most are either 90 or 180 days, though.) Any claims without payment by Day 45 should be checked on. If they are still pending, you are assured they have been received and meet the 60-day requirement. Without this follow-up at Day 45, there is a significant chance a claim will be denied for timely filing if a hiccup has occurred.

Once a claim is paid and there is a patient responsibility, the shift of obtaining patient payment begins. It is important to set up a strong billing cycle plan. Patients should receive two statements, one month apart. Statements should include an easy option on how to make a payment. At Day 90, the patient should receive both a letter and a phone call indicating the balance is over 90 days. Calls should continue throughout the month if there is no resolution. At Day 120, the patient should receive a pre-collection letter indicating status of payment and that this will be the final communication before hearing from the collection agency.

Payment plans are attractive to patients and allow you to maintain a good relationship with them. Create payment plans in writing and require the patient to sign the agreement. Only issue payment plans with credit cards on file – this allows you to control the payments rather than chase down your patient. Offer the least amount of payments possible in the plan.

Daily reports should be run from the PM system, indicating patients with balances and upcoming appointments. The front desk should be aware of the patients with balances and the reasons for those balances (e.g., deductible, co-insurance, unpaid copay, etc.). They should be trained on how to ask patients to pay old balances and be comfortable discussing balances and payment plans.

Use your registration paperwork to indicate that there will be additional charges if accounts go into collections. Added fees/percentages help to fray some of the costs from the amount the collection agencies will charge. Check your state laws for the fees or percentages you can add onto accounts.

In conclusion. RCM takes time and commitment. Each area of the practice is essential to its success, and it takes a leader to provide daily oversight of the process. Identifying the areas that are not maximized for reimbursement is the first step in improving your cash flow and setting your practice up for long-term growth.