Regular Reports Keep Collections on Track

Effective collections require running reports on a regular basis. Depending on the software you use, you may run reports by insurance company, and then by physician. Sorting the reports by insurance company increases staff efficiency because multiple claims with the same insurer can be reviewed, avoiding the need for repeated calls. Or, if your system has a collection management tool, you won’t have to run reports because delinquent accounts can be worked directly out of the system.
Always work the oldest or highest amount claims first. Pay attention to secondary claims: Have they gone out in a timely manner? Who is working them? Your company goal should be 45-52 days maximum in accounts receivable (A/R), with collections at 70-85 percent of billed totals, depending on the percentage at which your fee schedule is set.
Look at your benchmarks to see what is feasible for your office. One important benchmark is MPR, or Maximize Practice Reimbursement. MPR states that the job of the practice is to maximize practice reimbursement, while reducing the risk of an audit, by ensuring that you are coding/billing properly. The basic rule of thumb is: “If it isn’t documented, it wasn’t done.” This is true not only from a legal standpoint, but from a reimbursement standpoint as well.
Don’t forget to run Rejections and/or Error reports. If there are errors in your system when charges are filed electronically, and no one is working them, your A/R will be higher (that is, worse). Each system is different, and in some cases claims filed in error may stay in the 0-30 day bucket, and therefore never get worked. This, too, will skew your financial reports. Collection staff also needs to know how to work rejections from the clearinghouse.
Management should review the reports, and should sit down with the collections staff once a month, to see how each insurance company is paying. This will allow you to identify areas of concern, such as an insurer with a higher balance or delayed claims payment. Know your state law that determines how quickly an insurance company must pay following submission of a clean claim. In some states, the requirement is 30 days, in other states it is 45 days, etc.

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John Verhovshek
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John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.

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  1. Laura Bronaugh says:

    I would like to participate in the ICD-10 testing!! Thanx!!