Streamline Your Revenue Cycle: Part 2

Part 2: Fix patient registration errors to restore your practice’s financial health.

By Linda Martien, CPC, CPC-H, CPMA

The accuracy of patient registration is an important factor in whether claims are paid or denied. Overcoming registration errors is instrumental to the financial health of your practice, and requires consistent policies and procedures, education, and accountability. To ensure your practice is not losing vital income, let’s review some common mistakes practices make during the patient registration process.

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Dodge These Avoidable Mistakes

Here are the five common errors practices make during the patient registration process, with solutions for how to remedy the situation.

No. 1: Collecting insufficient or inaccurate financial data

This is an ongoing complaint from billing and collections departments. I’ve heard everything from “The schedulers didn’t obtain the right information when they scheduled the visit,” to “No one verified benefits,” to “The problem is data entry errors.” All of these are likely to lead to problem accounts and rising accounts receivable (A/R), and may be an indication of a failure to provide employees with sufficient training and performance monitoring.

If your front-line staff is slipping, you can’t ignore it. Counsel them and provide additional training. Hold each person accountable to a specific standard. It’s also important to evaluate workflow and determine what is a reasonable workload for each person to manage without sacrificing quality. This aspect of performance should count when it’s time for annual performance reviews.

No. 2: Asking the wrong questions

Collecting accurate demographic and billing information should not be limited to new patients. Because circumstances and policies change frequently, staff should update patient information and insurance information at each visit. Friends and family often accompany the patient, and may be a good resource when completing the registration process. A staff member who fails to do this should be held accountable.

Use the chart on the next page to help staff ask for and collect the right data when scheduling appointments or at the beginning of each patient visit.

No. 3: Piling up on unpaid services

Another headache for practices is monitoring patients with aged balances who keep coming in for additional services. Allowing patients who have not paid for past services to run up larger balances makes it even harder to collect.

Front desk staff must be trained and empowered to assist with collecting patient balances. One solution is to set up a system whereby accounts are reviewed one day before the patient visit. When there are existing patient balances, determine processes to support payment. For example, begin checking account balances when scheduling patients, and let them know payment is expected at the time of the visit. Then, when you call to remind patients about their appointments, remind them about the payment policy, as well.

It’s your staff’s job to ask the patient for payment when he or she arrives at the office. Receptionists and schedulers should be trained on how to audit a patient’s account, and to know when it’s time to have the patient meet with someone in the billing department. Determine the specific parameters for your staff so they can do the job you want and support each other. It takes a team.

No. 4: Untimely claims submission and
poorly designed patient statements

Either of these will thwart collection efforts. It’s important to generate charges in “real time,” so they are posted and electronically sent to the payer within 24 hours. Also, make sure your billing statement is formatted so patients can easily understand what they should pay, as opposed to what is pending from the insurance company. This will expedite payment. Even better, establish a system that allows patients to pay their bills online.

Further, establish specific billing targets, such as:

  • Charges must be submitted the day services are rendered.
  • Charges must be posted and insurance claims generated within 24 hours. (You might establish a longer time frame for surgical claims if you have a coder review the physician’s operative notes before submission.)
  • Patient statements should be sent within 10 days of service, and immediately following insurance payment.
  • Statements should include an aging of the balance and a message for delinquent accounts. Most billing software allows you to customize your messages and determine the criteria for when they should be placed on patient statements.

No. 5: Failure to analyze collection performance

Too often, staff is focused on getting the billing off their desk and the claims submitted, and have little time to follow up on receivables, analyze the practice’s financial performance, and improve collections. Monitoring overall performance requires consistently reviewing month-end reports and analyzing collection performance. The following reports will reveal trends and help you to identify where there are problems on the horizon:

  • Unpaid claims
  • Aging reports
  • Aging by payer class
  • Patient balance reports
  • Payer performance reports

During an initial visit, allow time for the business office or practice manager to meet with the new patient and review the policies regarding registration, accounting, and collection procedures. This is an excellent opportunity to build that essential trust relationship with the patient. Remember to:

  • Communicate effectively
  • Be natural
  • Avoid technical jargon that patients may not understand (e.g., HIPAA and other acronyms)
  • Take the time to answer questions

Your patients need to be knowledgeable about, and be held accountable for, their balances due after insurance has paid, or in the absence of insurance or other payer(s). A recommended practice is to review your credit policy with the patient and then have the patient sign the policy to indicate acceptance. Setting clear expectations and consequences will avoid confusion and misunderstandings. At this time the patient can also sign (at least) the following documents:

  • Acknowledgement receipt of a Notice of Privacy Practices
  • Consent to Treatment and Financial Obligations
  • Medicare Secondary Payer (MSP) Questionnaire (for Medicare beneficiaries)

Follow Up After Services

After all the necessary documents have been signed and the patient’s questions answered, what happens when insurance doesn’t pay, or doesn’t pay accordingly? Or you’ve mailed multiple statements of balances due to the patient, with no response? The following questions will help you to evaluate the patient collections process and identify opportunities for improvement:

  • Do front-desk employees consistently ask for co-pays? Try incentivizing them to collect patient payments by establishing performance targets and tracking performance over time. Some practices also incentivize front-desk staff by using a monthly bonus system.
  • Is your practice using its electronic health record (EHR) system to send out automated appointment reminders that include information about payments expected at time of service? Reminding patients of co-pays can help increase the amount of patient payments collected. If your practice is not already using automated appointment reminders through your EHR system, consider doing so. The reminders help cut down on no-shows, too.
  • Does staff check patient insurance eligibility and benefits at least two days before scheduled visits? Verifying a patient’s eligibility and coverage helps ensure clean claims and timely reimbursement, and can prevent financial losses due to ineligibility. You can automate this process via select practice management software solutions, saving valuable time for your staff.
  • How long are lag times between date of service and date of charge entry? Identify lag times. What about time between date of service and date of claims submission? The longer the lag times, the longer it takes to get the money you are owed. Speed up your cash flow by modifying workflows to decrease lag times.
  • Is your practice or facility optimizing use of medical management software? Streamline tasks and improve productivity and the claims process by taking advantage of all the automation capabilities within the system.

Collecting Patient Inormation

Information needed

Right way

Wrong way

Current phone Please confirm your home and work phone number for me. Are your phone numbers the same?
Current address Mrs. Smith, are you still living at 312 Windy Drive? Mrs. Smith, are you at the same address?
Employer Are you still employed by the City of New York? Have you changed jobs?
Primary insurance Is Aetna Preferred still your primary insurance? Do you have the same primary and secondary insurance?
Secondary insurance Do you have a secondary insurance coverage with UnitedHealthcare? Do you have the same primary and secondary insurance?
Workers’ compensation Is this visit related to a work injury or an auto accident? No question asked about the possibility of injury.

Create Policies and Get Staff Buy-in

Develop written financial policies that represent your philosophy and collection goals. The goals should be specific and identify employee responsibility. By including the entire staff in development and implementation of the policies, you get their buy-in, which is essential to achieving desired results. Here are some suggestions to include in your policies:

Do: 

  • Advise patients prior to their visit of your collection policy, preferably during scheduling.
  • Post signs in your office that advise patients of your collection procedures.
  • Offer discounts to patients who pay their bills in a timely manner.
  • Offer different payment options for patients who have high out-of-pocket expenses.
  • Require patients to make “good faith” payments.

Don’t: 

  • Let patients continue to accrue bills they cannot pay for, unless it’s an emergency.
  • Send accounts to collections without providing adequate time for patients to make payment arrangements.
  • Ignore delinquent bills. After services have been provided, patients may not have the urgency to pay without some prompting.

 

Linda Martien, CPC, CPC-H, CPMA, brings her 30+ years of experience in coding, billing, auditing, management and consulting to healthcare. She is a member of the AAPC Chapter Association board of directors for the 2014-2017 term, is a past member and officer of the National Advisory Board, and has held various officer positions for Columbia and Jefferson City, Mo., local chapters. She is employed as director of reimbursement at Cytomedix.

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Renee Dustman

Renee Dustman

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.
Renee Dustman

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About Has 428 Posts

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.

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