Successfully Managing Your A/R
by Tracey Erbert
President, in2itive Business Solutions
Amkai Newsletter
June 2011
When thinking back on her career as a business office manager, Tracey Erbert, president of in2itive Business Solutions, a fully integrated revenue management and health care consulting firm, identifies five best practices that allowed her to succeed for so many years in the ASC industry.
"Best practices are more important than ever," say Erbert, who has more than 22 years of ASC operational experience. "With many managed care contracts squeezing reimbursement, facilities have to be on top of their A/R game.
"Not much has changed since I started in 1988. The same day-in, day-out events occur, we’ve just had more added to our plates," Erbert said. "We don’t do a whole lot different today than I did my first day on the job. It’s all about following the five steps."
Tracey’s "Five Steps to Successfully Managing A/R" are:
- Verify benefits prior to service and contact the patient to be sure they're aware of their financial responsibility. Be sure to collect this before any procedure to prevent having to go back to the patient to collect additional, unexpected fees.
- Because of changes in health care, patients are opting for plans with higher deductibles and more out-of-pocket expenses. If you're doing out-of-network services, make sure to ask the payer for both in-and-out-of-network expenses to ensure that patient is covered properly for the planned procedure.
- Drop the claim within 48 hours. Don't wait a minute longer.
- The faster the claim gets to the payer, the faster the money ends up back in your hands. Be sure to stay on top of your docs to make sure they're dictating timely and attaching op reports to their paperwork. Many payers require extensive op reports for workers compensation fillings, so be sure to provide as much info on the claim as possible. They, payers, also want to see all invoices related to implants, so be sure to include those as well.
- Know your payer's requirements and be prompt and thorough on all claims, beginning with confirmation that the payer received the claim through your electronic clearing house or through online tracking where possible.
- As mentioned above, many payers require op reports and implant invoices in order to receive payment on your first pass through. This will prevent you from having to resubmit your claim or send in additional information, which will delay your payment. If you can confirm that they received your claim, plus all the necessary information, you'll be less likely to encounter delays.
- Call on all unpaid claims at 21 days after submission, and then at least every 14 days until paid. Keep on top of this to ensure that you're calling regularly until the payment is received.
- If your e-mail calendar or software system has the capability, program it with your daily call reminders. However, if you don't have that ability, use a written calendar or other electronic calendar to keep track of each day's calls and the next time that a claim should be followed up on. If you fall behind on your 14-day cycle, it'll only get that much harder to stay on top of claims that haven’t been paid yet.
- Track and trend denials each month to ensure you're not chasing the same type of errors. If you waste too much time chasing the proverbial White Rabbit you'll be running in circles, only to come up empty-handed again and again.
- Referring back to #3, know your payer's requirements. Consider every zero-pay as a denial. Be sure to track and trend every response to ensure you don’t submit future claims to the same payer and end up with the same denials.
- We trend every zero-pay and code every denial -- missing or invalid patient ID numbers, ineligible on date of service, no preauthorization or referral, wrong insurance, request for medical records, non-covered procedure code, additional information requested or timely filing. These are all issues that can be sourced to your staff, so you’ll want to keep track of the errors to prevent them from happening again. We tally and total monthly tracking percentage, month to month. We also keep a running annual log to keep our denials low. This allows us to see spikes, which permits us to see if it's a staffing issue or payer issue.
Erbert also notes that "The first thing that goes away, causing failure, is nothing more than keeping up to date and failing to follow through. If you don’t keep track of trends of denials, then you’re submitting the same type of claims to the insurance companies and getting the same denials."
Tracey Erbert has an exceptional track record of exceeding industry standards for A/R management and more than 22 years of ASC operational experience. Tracey's expertise includes process design and implementation, operational efficiency development, conflict resolution and accounts receivable management. Offering a rare blend of creative and operational strengths, Tracey has attracted a sound, capable staff committed to performance excellence and a focus on customer service.
in2itive Business Solutions, based in Overland Park, Kan., is a fully integrated revenue management and health care consulting firm. The company offers clients a team of professionals with extensive health care experience and the technology to provide virtual support that allows clients to retain their financial information while leveraging in2itive's resources. in2itive offers clients: total access to revenue management information 24/7; customized and highly personal services; industry-leading expertise; and, consulting on business office operations, managed care contracting, clinical operations, materials management and risk management.