Is the medical billing service you use causing your practice to lose revenue? Bad debt for medical practice is mostly caused by payer nonpayment, and many patients carry a past due balance for at least 60 days. If this appears to be the root of your practice’s problems, you may need someone who can analyze why claims for payment are being denied. Perhaps over time, you have noticed patterns in the revenue cycle which are not efficient or productive, causing the decrease in your practice’s financial performance.
You might be reluctant to make changes if you do not know specifically how to pinpoint the root of the problems and what to look for in a new service provider. Start by taking a closer look at the aspects of the process that your practice can manage, such as your patient volume, capacity and what you charge patients for your services. Also, it is ideal to have a thorough understanding of internal processes such as registration, insurance verification and proper code capture for the services offered. Following is a guideline to help ensure a smooth transition to a new provider.
Research Before Making Changes
Taking a look at the efficiency of your internal front office functions is crucial as they directly affect the financial performance of your practice. You will want to look at how the registration process flows from setting the first appointment to insurance eligibility and verification, medical coding to closing the account when paid in full.
While you have control over patient volume, capacity and charges for services, the external processes, such as managing payments from patients, insurance reimbursements, payment denial management, and collections, which are the true revenue drivers, are more difficult to manage internally. This is due to a usually long payment cycle that can stretch out into months as bills take time to generate and then can bounce between the payer, the insurance company, and the practice.
Some questions to ask include:
- What are the specific problems you are currently encountering with your service provider?
- Are you able to pinpoint the areas where you have experienced the most loss and why?
- What is missing in your Revenue Cycle Management?
A prospective provider should understand how to negotiate payer contracts, be familiar with proprietary rules from the various insurance companies and know how to track the efficiency of appeals that are rejected. Sometimes claims are paid below the contracted amount or services might not get billed at all due to oversights in the billing process or payments might even get rejected due to payer requirements. These are all revenue-lowering problems. An efficient provider should also be proficient in analyzing the cause of denials, know how to locate outstanding payments and adjust contract terms as needed.
Decide on Next Steps
If the problems are too complex, you may want to consider changing service providers altogether. Additionally, you could have a new service provider review the problems experienced by the previous company and propose a strategy to help reduce revenue loss moving forward. Alternatively, you could work with staff within your organization to manage the project.
Be a Part of the Training Process
You will want to start by including your staff in learning the new processes and to ask what is expected of them as far as managing the revenue cycle process to help ensure success. The first step would be to appoint a competent, experienced and respected Project Manager from your coding and billing department to manage the transition period. This person should fully evaluate the internal processes mentioned previously, starting with the first point of contact with the patient at registration and follow through.
Make Support a Priority
When selecting a new billing services provider, you should not neglect the importance of customer service rather than focusing primarily on qualities that are likely to ensure the desired financial results. Additionally, you will want to consider features, price, and quality of services. There must be good workflow between the internal and external functions. You are more likely to receive payment for the use of an electronic medical record, which is more efficient, impacting how the initial visit is documented including how the diagnosis is coded.
Finally, before selecting a service provider, ensure that they are credentialed by the Healthcare Billing Management Association, the American Health Information Management Association, or the American Academy of Professional Coders. Internally, make sure that you take time to understand the payment and collection processes for past due payments, ensure that your staff knows how to code for the highest revenue and keep informed on changes within the industry. Finally, take time to make sure your practice is using electronic processes for documentation from the first point of contact with the patient.