patient collections

01
Nov
2013

BEST PRACTICES FOR REDUCING PATIENT NO SHOWS

In today’s health care environment patients have more responsibility for paying their medical bills. In the new environment, patients are responsible for paying higher copays and have high deductibles. With the decrease in reimbursements from the insurance companies, medical practices must run a tight schedule in order to maximize the revenue that they generate. An important aspect of practice management is to ensure that patients show up for their scheduled visits. It is not uncommon for patients to not show up for their visits without providing notice to the medical practice. A no show from a patient means a loss of revenue that can be important to the financial well-being of the practice. Moreover, a patient no show prevents the medical practice from collecting copays from patients and sending a claim to the insurance company.

In order to reduce patient no-show, medical practice must put in place a process to discourage patient from missing scheduled appointments. This process can be broken down into four simple steps.

The first step in the process is for the medical practice to develop a patient no show policy and make patients aware of it. The practice must make an effort to stick to the rules in the no show policy at all times to ensure that patient no shows are minimized. The patient no show policy should be as simple as having rules for cancellations, missed appointments.

The second step in the process is for the practice to communicate the no show policy with its patients. The no show policy should documented the practice’s policy regarding no shows along with consequences of missed appointment. Some practices charge a certain amount for missed appointments. The policy is to be reviewed and signed by the patient. Patients must provide enough notice to the practice if they need to cancel an appointment.

The third step in the process is for the practice to make calls to patients scheduled to be seen 24 hours before their scheduled appointment. Calls can help catch cancellations giving the medical practice enough time to schedule the cancelled slot with another patient.

The fourth and final step in the process is to communicate with patients that failed to show for their appointment. Communicating with patient that have missed appointments helps build rapport and trust. At the same time, it allows the practice to check any unusual situations behind the appointment have been missed.

It is important that practices communicate with their patient the importance of showing up or making arrangements in the case that an appointment needs to be missed. Opening a dialog with patients regarding the importance of showing up will improve a practice’s bottom line.

To recap, some best practices for preventing no shows are:

1. Develop a no show policy and make patients aware of it.
2. Communicate the no show policy to all patients.
3. Make appointment reminder calls to all patients 24 hours before their appointment.
4. Communicate with patients that fail to show up for their scheduled appointments.

At Vitruvian MedPro Consulting, we are more than medical billers. We are certified medical reimbursement specialists by the American Medical Billing Association. We can help medical practices at any stage of the revenue cycle management process. Our goal is to help medical practices improve cash flow and focus on patient care.

Please visit our medical billing page to learn more about our services at: Medical Billing Services

We are currently offering a free practice analysis to help medical practitioners determine whether it makes sense to outsource their billing. Gives us a call at 781-454-7406 and schedule your free demo.

At Vitruvian MedPro, a Brookline, Massachusetts medical billing and practice management company, we work with independently owned medical practices on any aspect of their revenue cycle management. Besides medical billing, we help medical practices with their coding, account receivables and HIPAA compliance. We make sure that practices receive the highest reimbursements from the insurance companies.

26
Sep
2013

THE MEDICAL BILLING PROCESS NEEDS A GOOD PATIENT COLLECTION SYSTEM

Medical Billing is one of the most important functions of a medical practice. Medical Billing is part of the revenue cycle management process of a practice. So, medical billing is much more than submitting claims to insurance companies and waiting to be paid for those claims. The revenue cycle management of a medical practice is a complex process that involves: insurance verification, patient demographic entry, medical coding, charge entry, claims submission, payment posting, patient collections, denial management and reporting. In order to ensure financial success, medical practices must put in place a solid revenue cycle process. Putting in place the steps that the practice staff needs to ensure that every step of the revenue cycle management process is worked will save the medical practice money and will increase revenue in the long run.

At the center of the revenue cycle management process, is patient collections. Current trends in medical insurance are putting more responsibility on patients due to higher co-pays and higher deductibles which patients are responsible for. Also, patients that have no health insurance are responsible for paying the medical services they receive. A good patient collections process will make the revenue cycle management process runs smoothly. Moreover, having a good patient collections process will ensure that the medical practice gets the money patients are responsible to pay.

One of the best practices that medical practices should implement is to set patient collection expectations up front before the patient gets seen or during the patient’s visit. Not discussing patient collection responsibilities up front can damage the relationship between the medical practice and the patient when a bill is sent to the patient after the visit. It is not uncommon for patients to dispute and fight a medical bill when they are not made aware of their responsibilities up front. Sharing patient payment responsibilities up front will set ground rules and will make patients be aware of their responsibilities after they receive care.

Medical practices must make sure that they obtain patient insurance coverage and eligibility before the patient shows up for a visit. Providing patients with the copay and deductible responsibilities will set payment expectations up front and will prepare the patient to receive statements from the practice. A good practice management system can provide eligibility and coverage information to the practice on the spot saving the practice staff time from calling the patient’s insurance company. Ass an added benefit to the practice processes, a printed copy of the insurance coverage and eligibility information can be provided to patients from the get go as a way to engage them in the collection process.

Medical practices must also make sure that once patients are aware of their coverage and eligibility benefits, they collect patient co-payments at the time the patient walks in for a visit. It is good practice to let patients know in advance how much they will be expected to pay when they come in for a visit and how much they will be expected to pay after the insurance processes the claim.

To conclude, in order to improve their patient collections, medical practices should:

1. Educate and guide patients on their insurance coverage and eligibility.
2. Inform patients of their financial responsibilities at the time of check-in, prior to coming to a visit or when booking the next visit.
3. Make sure that your practice has an up to date practice management system that will allow you to check benefits and track patient balances.

At Vitruvian MedPro Consulting, we are more than medical billers. We are certified medical reimbursement specialists by the American Medical Billing Association. We can help medical practices at any stage of the revenue cycle management process. Our goal is to help medical practices improve cash flow and focus on patient care.

Please visit our medical billing page to learn more about our services at: Medical Billing Services

We are currently offering a free practice analysis to help medical practitioners determine whether it makes sense to outsource their billing. Gives us a call at 781-454-7406 and schedule your free demo.

At Vitruvian MedPro, a Brookline, Massachusetts medical billing and practice management company, we work with independently owned medical practices on any aspect of their revenue cycle management. Besides medical billing, we help medical practices with their coding, account receivables and HIPAA compliance. We make sure that practices receive the highest reimbursements from the insurance companies.

30
Jul
2013

Medical Billing Optimizing Revenue Generation

On a day to day basis a medical practice is busy with taking care of patients and running the back end operations. The staff is busy scheduling patients, seeing the daily inflow of patients, calling insurance companies to request authorizations or follow up on claims, etc. In such a dynamic and hectic environment it is not uncommon to see mistakes being made that result in the reducing revenue and increasing expenses.

Whether the practice does its billing in house or it outsources this function, mistakes can be avoided by putting processes in place that will help the practice staff be more efficient while optimizing revenue generation for the practice. Following are five recommendations that medical practices can implement in order to improve their day to day processes:

1. Make a copy of patients insurance cards

An office policy must, is to always make photocopies of patients insurance id cards. Insurance cards can be scanned directly into the practices EMR or can be copied and scanned into the EMR system. Insurance ID cards should be copied or scanned on both sides as they provide important information that is required to submit a claim. The practice must educate its patients on bringing in their newest insurance card every time they come for an appointment even if they claim that the information has not changed. There are instances when the patient is not the primary policy holder of the insurance and is not aware of any changes to the insurance policy. Also, employers may change insurance companies or change plans requiring the practice to update the insurance information in its system.

2. Putting in place a system to submit claims on time

Filing medical claims in a timely manner is vital to a medical practice financial success. The sooner a medical claim is filed, the sooner the practice will get paid. Most insurance companies have time frame limits for a practice to submit a claim from the date of service. Claims that are submitted even a day late from the insurance time frame limit requirements will be denied and the practice will not get paid. Claims that are filed outside of the time limit set forth by the insurance companies will not get paid. Insurance companies time filing limits vary from company to company, the medical practice must be aware of the time filing limits of every insurance company the practice files claims with.

3. Reviewing the practices coding practices

Medical coding translates what took place during a patient visit and determine the level of payment that a medical practice will receive. It is important for medical practices to review their coding practices on a regular basis to make sure that the practice is not under-coding or over-coding. The person doing the coding should be the provider diagnosing the patient or a certified professional coder that can translate what was documented during the patient’s visit into the proper diagnosis and procedure codes. When hiring a certified professional coder, medical practitioners should provide detailed encounter documentation so that the coder can assign the correct diagnosis and procedure codes to the visit.

4. Reviewing clearinghouse reports

Most medical practices today submit their medical claims electronically through a clearing house. Clearinghouses provide a report after a claim has been submitted with information regarding the submission. Some claims will pass through the clearinghouse and get submitted directly to the payer while some claims get rejected and are sent back to the sender for review. Reviewing clearing house reports on a daily basis will ensure that those claims that get rejected at the clearinghouse level get reviewed, fixed and re-submitted on a timely manner. Not reviewing clearinghouse rejected claims on time can result in late time filing submissions which result in the practice not getting paid. Some claims that are rejected at the clearinghouse level can be easily fixed and re-submitted.

5. Follow up on claims and obtaining aging reports

Practices must make it a standard operating procedure to run aging reports on a regular basis. Aging reports will help the practice follow up and take action on the outstanding claims that have not been paid. Not following up on aging reports can cost the practice a lot of money. The hectic day to day operations of a medical practice may prevent the staff from regularly checking the status of the practice claims until someone notices that cash flow levels are down. Regularly running aging reports and follow up of the reports will help reduce insurance denials and rejections.

Please visit our medical billing page to learn more about our iClaim services at: Medical Billing Services

We are currently offering a free practice analysis to help medical practitioners determine whether it makes sense to outsource their billing. Gives us a call at 781-454-7406 and schedule your free demo.

At Vitruvian MedPro we work with medical practices of all sizes with any aspect of their revenue cycle management. Besides billing, we can help practices with their coding, account receivables and make sure that practices receive the highest reimbursements from the insurance companies.

Outsource Medical Billing
15
Jul
2013

Medical Billing Fighting Timely Denials

Know your state’s law on timely filing limitations. Also, you should know the time limits for all carriers in which your doctor/client participates with. The contract for participation will define timely limitations.

Example from BCBS of Arizona: BCBSAZ asks providers to submit complete and accurate claims, preferably within 30 days of service, and require submission within one year of the date of service. BCBSAZ will deny any claims received more than one year after the date of service. Members are not liable to a BCBSAZ contracted provider for payment of a claim on which BCBSAZ denied payment for lack of timely filing. For the Federal Employee Program (FEP), the claim submission deadline is December 31 of the year immediately following the year in which service was rendered.

For paper claims – always send certified/return receipt so you have proof the claims were received. You can use the return receipt for proof that the claim was received timely.

For faxed claims
– always ensure that your machine prints out a “faxed received” message you can use as proof that the intended party in fact did receive your fax.

For electronic claims – use your clearinghouse submission report as proof a claim was submitted timely. Some carriers will accept a “print screen” printout of the filed date from your billing software program.

Non-participating Payer Denial

The Benefit Argument – this argument is one you can use to appeal to the carrier by framing it as 1) we are not obligated to file claims on behalf of your insured. 2) Your insured purchased health insurance in good faith and this is a covered benefit they are entitled to receive benefits for. In the above example (BCBS AZ) the patient would have had up to a year, so you could throw that date out since the provider isn’t obligated to file a claim for non-participating (excluding Medicare) carriers.

ERISA

And finally, ERISA can be your best defense. Under ERISA, state law has no jurisdiction, and neither do plan limitations. See 29 USC 18, 1003(a) and 1144(a) http://codes.lp.findlaw.com/uscode/29/18/I/B/5/1144 and US Supreme Court Decision in Davilla vs. Aetna and Calad vs. Cigna for references. Note that you must have the patient’s written permission to pursue an ERISA violation/denial unless the patient is willing to pursue denial him/herself.

At Vitruvian MedPro, we help medical practices increase cash flow by making sure that all claims are submitted on time. Claims submission status is followed up on a regular basis to make sure that the providers gets reimbursed for the services provided. Our state of the art practice management system helps us stay on top of the revenue cycle of every practice. For more information visit our web site at:

11
Jul
2013

Outsource Medical Billing

Medical practices and medical professionals often debate whether they should do their billing in-house or whether they should outsource their billing to a medical billing service.

At Vitruvian MedPro, a Massachusetts Medical Billing company, we believe that by outsourcing their medical billing, medical practitioners will benefit by having more time to provide patient care. By eliminating the worry of having to process their medical claims, medical practitioners can devote all their time to provide patient care. Moreover, medical practitioners can grow and expend their book of patients. Outsourcing to a company with a high level of expertise in medical billing and medical coding will increase collections and provide stability to the financial workflow of the practice.

Medical Billing Companies provide another advantage to medical practitioners as they are on top of all the new regulations related to the medical billing process. Following all the new changes and regulations can distract a medical practice from concentrating in providing care. A medical billing services can integrate the new changes and regulations to the practice’s billing workflow without disrupting the day to day operations of the practice.

Practices that do their billing in-house have to hire staff which becomes an additional expense to the practice. Furthermore, doing billing in-house will add costs related to software implementations, employee training and employee turnover. It has been proven that medical practices save money by outsourcing their medical billing as it the overhead costs to run the practice.

At Vitruvian MedPro we work with medical practices of all sizes with any aspect of their revenue cycle management. Besides billing, we can help practices with their coding, account receivables and make sure that practices receive the highest reimbursements from the insurance companies.

Please visit our medical billing page to learn more about our iClaim services at:

We are currently offering a free practice analysis to help medical practitioners determine whether it makes sense to outsource their billing.

21
Jun
2013

Vitruvian MedPro Logo Sml

Welcome and thanks for checking out the first blog post in our brand new site! We plan on posting information on a regular basis regarding revenue cycle management and practice management topics. We are currently helping medical practices improve cash flow by providing Medical Billing, Medical Coding, and Patient Collection services. We are also actively working on helping medical practices with the HIPAA compliance programs.