ED Coding and Reimbursement Alert

Once you know if you have an A/R problem, you can consider the solutions.

The combination of a pandemic and an economic downturn means that many EDs are under more pressure than ever to collect every penny. You can refine your accounts receivable (A/R) process quickly and easily to bring in the money without a lot of extra effort.

A/R defined: Accounts receivable (A/R) is the money that is owed to the practice, said Scott Hudson, partner development manager with ECL, during the firm’s March 26 webinar, “Improving Your Practice’s Revenue Cycle Management.”

If you get too far behind in your collections, it could cost you time and money down the line, Hudson said. “Administrative costs are 30 percent of expenses in healthcare,” Hudson said. In fact, he noted, administrative costs continue to rise, and billing-related costs rose 21 percent from 2009 to 2012.

Consider three quick tips to ensure that you keep collecting what your ED is due.

1. Monitor Each Claim You Send Out

The first step in perfecting your A/R process is to make sure someone in your practice is paying attention to what happens to every claim you submit. Ask questions such as: “Did the insurance company even receive the claim?” and “Did the patient pay her copay portion of the bill?”

There are some practices that follow a “code it, bill it, and forget it” philosophy. They code the claim, they bill the claim, and then they forget about it, without following up to ensure that the money arrives.

Following up on your submitted claims early in the game can save you time. First, ensure that once your practice submits a claim that it is accepted. If the claim is rejected, the first order of business is to research why. Catching it in the initial submission phase saves you time in the long run and ultimately gets your money in the door faster.

Set a reminder: Try placing an event reminder on your digital calendar every week that reminds you to check all accounts receivable for the past 30 days. Print a report and go online or call to check claim statuses.

2. Follow up on Unpaid and Denied Claims

Many practices have hidden money waiting to be discovered, which can often be found in the form of the following issues:

• Unpaid claims
• Claims paid incorrectly
• Denials not appealed or appealed incorrectly
• Denials appealed with no follow up

You should continually review and monitor your explanations of benefits (EOBs), paying special attention to your denials. You can glean a lot of information from your EOBs, such as how quickly insurers are paying you, whether your fee schedule is adequate, if your coders are coding properly, why insurance companies are denying your claims, and if you’re getting paid according to your contracted rates.

3. Run Reports and Update Your A/R Procedures

You can’t manage your A/R if you can’t measure it, so you need to produce a variety of reports to help you evaluate your A/R.

Tip: Invest in a good practice management system and learn all of its capabilities. Pay special attention to the reporting abilities of the system you use to be sure you get the data you need to manage your practice’s A/R, such as the practice’s gross collection rate, net collection rate, and average days in A/R for claims. You can then use this information to evaluate the effectiveness and efficiency of your practice’s A/R management.

Know the Collections Basics

Collections can be hard enough to manage without mastering all the jargon as well. But when people talk about days in accounts receivable (A/R), they’re referring to a tool that your practice should be using. Check out the following explanations of terms and concepts you should know when working on your A/R.

What is “days in A/R?” This is a single number that tells you on average how long it takes you to get paid after you provide a service.

Why should you bother to calculate your days in A/R? This number allows you to calculate whether your collections time is improving, but it’s also useful because it may mean something to your doctors.

When you talk to the ED physicians about the thousands of dollars people owe your practice, it can be difficult for them to relate to that large, abstract number. But if you tell your physicians, “If you have a critical care visit today, it’s going to take you 60 days before you get paid,” that gives them a more tangible understanding.

How do you calculate days in A/R? First you need to figure out your average daily charge (ADC). You get this number by dividing your gross charges by 365. Then you divide your total accounts receivable by your ADC to get the number of days in A/R you have outstanding.

How do you deal with an A/R problem? There’s no silver bullet. Often, the bulk of A/R will be patient accounts, such as copays and deductibles. Nobody wants to collect patient accounts because they’re tough and labor intensive.