8 Bulletproof Strategies to Get More Money Into Your Practice Faster

Obamacare and Health Insurance Exchanges are driving more patients to you, but patient financial responsibility is sky-rocketing due to super high deductible insurance plans.

Instead of fighting with claim denials and patient collections, learn how to maximize the amount you collect at the time of service and fill the leaky holes in your revenue cycle.

Strategy 1: Have an Eligibility Verification Sentinel

You should have a well defined process in your office with one staff member in charge of all patient visit insurance eligibility verification’s.

There are now many online portals available which help to perform these tasks more efficiently. It is important to understand the enrollment periods for each insurance network.

Availity and Navinet are two great resources to help make your eligibility work easier.  (Visit http://www.availity.com and Navinet.)

Get your verification done as early as possible so that communication with the patient happens well before the time of visit. Call 2-3 days before the visit to notify the patient what their financial responsibility will be.

Strategy 2: Collect All Patient Responsibility Fees

In the age of the Affordable Care Act and the Health Insurance Exchange plans, very high deductible health plans are becoming the norm.

Collecting patient responsibility goes beyond just the visit co-pay.

You can and should be able to estimate the visit costs at the time of service and collect a portion against the outstanding deductible and coinsurance amounts at the time of service.

Strategy 3: Learn How to Code Better

You need to be armed with three main weapons in order to code each visit for maximum reimbursement.

  1. An understanding of how the visiting patients insurance network pays for your common codes.
  2. How to perform and document a patient encounter visit at the highest possible level.
  3. Know which key diagnosis codes Medicare deems medically necessary for that particular visit. (Be aware of how ICD-10 will benefit you and help code more accurately)

Strategy 4: Submit Speedy Air Tight Claims

Submit claims as soon as possible that have proper documentation. Submit 100% complete patient demographic information and follow the insurance networks submission guidelines.

This will help to avoid claims being denied based on incomplete information and delaying the time it takes to receive that money into the practice.

Strategy 5: Create a Denial Diary

Create a journal using a spreadsheet tracking which codes are commonly denied for which insurance networks.

This will allow you to identify trends to understand which types of claims are getting denied and why.

Many of the better practice management software systems now help to collect this information for you. You should be reviewing these reports and posting them somewhere where everyone can see you’re holding training programs.

Strategy 6: Have a Solid Financial Policy in Place

Have clear and well documented patient financial policies in place such as when payments are due, when they go to collections, and even fees for outstanding accounts.

Most importantly, there should be a policy about visit restrictions for patients (and family members) that have high outstanding balances. They should all be clearly communicated and signed off on at the time of visit as part of the financial policies agreement.

Strategy 7: Plan to Follow Up Constantly

Working and reworking claims is the process of following up on claims that are denied, restricted, or delayed. Often the insurance plan will request claim adjustments and resubmission for denials.

Learn how to do this efficiently so you maximize the amount you will receive for that claim. This requires time and man hours and/or very good communication with your billing vendor.

Strategy 8: Keep an Eagle Eye on the A/R Buckets

You should absolutely be looking at the changes in your accounts receivable buckets monthly at minimum, bi-weekly is preferred. The likely-hood of collecting the full claim amount goes down the longer a claim sits in collections.

Wrapping Up

The most important thing to understand about your revenue cycle is that there are many moving parts that have variables which seem daunting at times.

By raising your awareness and putting simple tools in place you can have better visibility into how money is flowing into your practice and where to make adjustments.

About The Author

James Riviezzo

Over the past decade, I have served over 50,000 (mostly) satisfied patients. I have tracked measured and documented what makes a successful practice inside (and outside) the third party payer and oversight system of medicine.