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It’s happening more and more: Payers are denying routine services and finding invisible clerical errors in claims, bills are being "lost," and it’s taking longer and longer for bills to be paid in full. Pressed by financial problems, many HMOs and other insurers are simply using any excuse possible to find ways not to pay legitimate claims, say reimbursement experts. Here are some tips to help your practice reduce claim denials, speed turnaround time, and boost cash flow:
1. File frequently. Most experts recommend you have the bill prepared and out the door within three to four days after service has been rendered. Anything less, and you are just making the payer what amounts to an interest-free loan. Some offices prefer to file claims even more frequently. Frederick (MD) Internal Medicine makes a habit of filing claims daily. Besides speeding cash flow, daily filing reduces paperwork by processing claims on a same-day schedule rather than waiting to do a week’s worth of claims at once.
2. Know what you are due. "It’s been my experience that a great many carriers are failing to reimburse practices based on their negotiated fee schedule," says Brian Kane, CPA, president of HealthCare Advisors in Annandale, VA.
To help track what you are being paid vs. what you should receive, Kane suggests creating a simple grid with the insurance companies across the top and the main 10 to 15 CPT codes on the left side. Next, fill in what insurers are contractually required to pay for these procedures, then check these amounts against explanations of benefits (EOBs) received from payers.
The EOB differences may seem small, maybe as little as five or ten dollars per patient. But this small change can add up to big bucks over the course of a year. Plus, the more aggressive you are in auditing and demanding full payment, the less likely it is payers will continue pulling the same tricks.
3. Track denied claims by payer and code. The more information you have at your fingertips, the easier and faster it is for you to spot and correct underpayment patterns of particular carriers.
4. Collect copayments and deductibles quickly. Rather than billing patients, most reimbursement experts suggest you collect any copayment due before the patient leaves the office. When this is not possible, some practices have found that giving the patient a pre-addressed envelope to use to mail in the payment improves collection rates. The same attitude should apply when the patient is responsible for a deductible in his or her coverage.
One way to easily track this is to create a chart of your top CPT codes and most frequently encountered insurers, listing their deductibles and co-pay policies for each code. Your front office staff can then easily refer to this chart to improve collection rates.