Assessing Your Practice’s Billing and Collections

The process of billing and collecting medical payments consists of a very precise series of actions performed in sequence to obtain full reimbursement in a timely manner. So, in order to be able to accurately and objectively assess the efforts of one’s own Billing Department, the executive over that area would need to fully understand that sequence of events pop hit. The billing process begins with the complete and accurate collection of all necessary information from the patient. This is then correctly entered into the billing system. There are numerous opportunities for errors to occur here. With the patient’s insurance information in hand, their insurance eligibility and benefits must be verified and potential authorizations must be obtained. And ideally, this is performed prior to the patient’s first visit. The therapist can now evaluate and treat the patient which then requires that provider selecting the correct billing and diagnosis codes and that information getting to the biller in a timely manner. This information can be transferred in a number of ways, depending on the varying technologies incorporated within your practice. The biller must then ensure correct formatting for the various payers and then submit the claims electronically or via paper if required with accompanying documentation. Once payment arrives, those EOB’s (Explanation of Benefits) or ERA’s (Electronic Remittance Advice) must be correctly posted to the correct patient accounts and secondary claims must be sent out with copies of the EOB’s, or patient statements may be sent out. There must be some type of system in place which notifies the biller/collector when payments are not being received in a timely manner (for each patient account) so follow-up activities can be initiated to determine why payment is not being received and what needs to be altered to get that claim/s processed with payment. Once an account is paid in full there should then be some communication which the area of the practice responsible for the promotion of the practice so communication can be maintained with that patient to prevent them from forgetting that you exist and encouraging or incenting them to become a frequent and legitimate referrer to your practice. Each of these steps possesses multiple possibilities for errors and/or omissions which can delay payments at best, or cause denials at worst. In future articles, we will dig deeper into each area to provide a more thorough understanding and hopefully improve your practice’s billing and collecting efforts.