April Sackos, director of business office operations for Meridian Surgical Partners, shares six common mistakes made during the collections process and offers insight on how to avoid making them in your ASC.
1. Outdated collection tools. An updated insurance matrix outlining each contract is an important tool for collectors. Also, verify that all contracts are loaded in your system correctly. Loading all payor contracts enables collectors to evaluate if you received payment at the contracted rate. Also, if you receive your payor news bulletin electronically, make sure you keep them in an accessible shared e-folder and that everyone knows how to access them. If you receive updates in hardcopy, place in a binder and ensure that your staff is reviewing them in a timely manner.
2. Inadequate staffing. Look at how many accounts each collector is assigned. Typically, one collector can effectively work 800 accounts a month of your outstanding A/R. This can vary depending on your case mix, but is a good benchmark to follow.
3. Lack of insurance verification/lack of upfront collection of patient responsibility. Facilities must have an insurance verification process in place and verify insurance 3-5 days prior to the procedure. Always verify that the patient demographic information is correct. It is very important to discuss benefits information with patients prior to their date of surgery and that financial responsibility information is given to the patient in writing. If there is an amount due, make every effort to collect the amount prior to surgery. If the patient can't pay the full amount, set up a payment plan and obtain a promissory note and verify there is a process in place to ensure accounts are paid as agreed.
4. Claims not filed in a timely manner. Billing and collections go hand in hand. It is critical for your staff to be familiar with your payor contracts regarding their requirements for the timely filing of claims. Have solid procedures in place at your ASC for capturing charges and the necessary claim information on procedures to file claims within the required timelines. Verify that claims that need to be submitted hardcopy are going out in a timely manner with the supporting documentation and not going electronically. Verify that your staff is reconciling their electronically transmitted claim reports. Many times a claim was rejected by a payor during the electronic transmission process and is just sitting out there.
5. Not tracking denied claims. It is important to be persistent and closely track your denied claims. Check the explanation of benefits closely for denial reasons and have a tracking system in place. Tracking denials via a denial log or through your patient software will also help identify areas that need improvement. It is also important to know the payors' guidelines and timelines for appealing a denied claim and follow them closely.
6. Inadequate claims follow-up. All too often you see that a collector has taken the time to do the initial follow-up on an account and then it may sit there for months before it is looked at again. There are a lot of great reporting systems out there, but you need to have a solid internal process in place to make sure that accounts are not falling through the cracks. Depending on the carrier, you should be following-up every 15-20 days until the claim has been paid. It is also very important that all work is documented in your patient accounting system.
Learn more about Meridian Surgical Partners.
1. Outdated collection tools. An updated insurance matrix outlining each contract is an important tool for collectors. Also, verify that all contracts are loaded in your system correctly. Loading all payor contracts enables collectors to evaluate if you received payment at the contracted rate. Also, if you receive your payor news bulletin electronically, make sure you keep them in an accessible shared e-folder and that everyone knows how to access them. If you receive updates in hardcopy, place in a binder and ensure that your staff is reviewing them in a timely manner.
2. Inadequate staffing. Look at how many accounts each collector is assigned. Typically, one collector can effectively work 800 accounts a month of your outstanding A/R. This can vary depending on your case mix, but is a good benchmark to follow.
3. Lack of insurance verification/lack of upfront collection of patient responsibility. Facilities must have an insurance verification process in place and verify insurance 3-5 days prior to the procedure. Always verify that the patient demographic information is correct. It is very important to discuss benefits information with patients prior to their date of surgery and that financial responsibility information is given to the patient in writing. If there is an amount due, make every effort to collect the amount prior to surgery. If the patient can't pay the full amount, set up a payment plan and obtain a promissory note and verify there is a process in place to ensure accounts are paid as agreed.
4. Claims not filed in a timely manner. Billing and collections go hand in hand. It is critical for your staff to be familiar with your payor contracts regarding their requirements for the timely filing of claims. Have solid procedures in place at your ASC for capturing charges and the necessary claim information on procedures to file claims within the required timelines. Verify that claims that need to be submitted hardcopy are going out in a timely manner with the supporting documentation and not going electronically. Verify that your staff is reconciling their electronically transmitted claim reports. Many times a claim was rejected by a payor during the electronic transmission process and is just sitting out there.
5. Not tracking denied claims. It is important to be persistent and closely track your denied claims. Check the explanation of benefits closely for denial reasons and have a tracking system in place. Tracking denials via a denial log or through your patient software will also help identify areas that need improvement. It is also important to know the payors' guidelines and timelines for appealing a denied claim and follow them closely.
6. Inadequate claims follow-up. All too often you see that a collector has taken the time to do the initial follow-up on an account and then it may sit there for months before it is looked at again. There are a lot of great reporting systems out there, but you need to have a solid internal process in place to make sure that accounts are not falling through the cracks. Depending on the carrier, you should be following-up every 15-20 days until the claim has been paid. It is also very important that all work is documented in your patient accounting system.
Learn more about Meridian Surgical Partners.