Best Practices When Sending Patients to Collections

patients collectionsAs Patient Payment Responsibility continues to increase, sending patients to collections efficiently & effectively is more critical to the financial health of your practice than ever before. Here are some helpful tips to optimize your patient collections process.

  1. Communicate your collection policy upfront
  2. Integrate your collections process with your billing
  3. Consider offering discounts for self-pay patients
  4. Accept multiple forms of payment 
  5. Offer multiple payment options
  6. Require patients to make “good faith” payments

Practices that employ the following practices can help prevent sending patients to collections or make the collections process much more efficient and effective.

1.Communicate your collection policy upfront

Prior to patient appointments, clearly communicate your collection policy. This helps the patient plan ahead to pay in full in the specified time period. This is especially important for patients that must meet a deductible or coinsurance amounts towards the out of pocket expenses. When patients are aware in advance, they are more likely to make some of their payment upfront. In addition to pre-visit communications, specify your collections with signs in your office, intake forms, information documents and on your website.

2. Integrate your collections process with your billing

The current process to send patients to collections is tedious, time-consuming and prone to error and miscommunications. That’s because staff must constantly and manually pull lists of patients eligible for collections and send all the necessary patient information to the agency. Plus, all the complex back and forth communications, followed by posting accounting for the payments.

Leveraging an automated patient billing system like BillFlash, you can create rules based on aging and minimums that queue up patients eligible for collections and send all the necessary information to begin the collections process. Practices can manage the entire collections process right in the patient billing system including setting rules, approving accounts for collections, and reports. To learn more, call NexTrust BillFlash at 435-940-9123 or visit collections.billflash.com

3. Consider offering discounts for self-pay patients

While insured patients receive discounts through their insurance provider, self-pay patients are responsible for their full payment. As an incentive to pay bills in a timely manner, offering self-pay patients a discount to pay in a timely fashion could reduce accounts sent to collections, improve the patient payment experience, and help improve your cash flow.

4. Accept Multiple Forms of Payment

Limitations in accepted payment methods and payment options can be a liability for your practice in getting paid quickly, and sometimes, getting paid at all. You can remove these barriers by incorporating payment systems that make it easy to accept all card types as well as payment plans. The BillFlash Billing and Payment system lets you offer these payment options to your patients simply. Patient billing and payments can then be synced with EZClaim because of the existing integration with BillFlash.

5. Offer Multiple Payment Options

Patients may find themselves in collections because out of pocket expenses are often much higher than they expected and can sometimes be thousands of dollars. Offering various payment methods and payment plans improves the patient experience and overall satisfaction.

Limitations in accepted payment methods and payment options can be a liability for your practice in getting paid quickly, and sometimes, getting paid at all. You can remove these barriers by incorporating payment systems that make it easy to accept all card types as well as payment plans. The BillFlash Billing and Payment system lets you offer these payment options to your patients simply. Patient billing and payments can then be streamlined because of the existing integration with BillFlash.

6. Require patients to make ‘good faith’ payments

If a patient is not paying their balance in full, requiring them to pay a portion of the payment is a helpful first step in keeping their commitment to fully meeting their financial responsibility. These small steps not only make the debt more manageable for patients but creates payment momentum for future payments so that at 90 or 120 days they owe much less and are less likely to be candidates for collections. 

With increasingly more patient payment responsibility, the risk for patients being sent collections can rise as well. So, helping your patients avoid collections and optimizing your collections process when collections become necessary, can bring big financial returns

Call NexTrust today 435-940-9123 or email at sales@billflash.com or go to collections.billflash.com to learn how collections are now integrated with automated patient billing and payments to improve the financial health of your practice.

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Reducing Denials

reducing denialsDenials are a concern for every provider and institution. Denials stress every aspect of revenue cycle management as they eat away at the bottom line, stress cash flow, and subsequent operations, and drain and entangle administrative, clinical, and financial resources during appeals. IMO has the tools you need to aid in reducing denials.

Some estimates suggest that as much as 9% of claims are denied annually and with ~$3.6 Trillion in spending in 2018, ~$324 billion in claims were denied, initially. Fortunately, 63% of claims that were denied were recovered, but not without a cost.¹,²

A closer look at the causes for denials, suggests that missing or invalid claim data and medical coding accounted for 20% of denials.¹ Without a doubt, these mid-cycle and back end processes are critical components to efficient revenue cycle management. 

We understand how important it is for practice managers to align clinical descriptions documented at the point of care to the correct ICD-10CM codes to ensure accurate coding and appropriate reimbursement. 

IMO knows how challenging it can be to translate diagnoses documented in a provider’s clinical language to the appropriate ICD-10CM codes, especially when code sets change. 

Furthermore, we understand the risk to the bottom-line if diagnoses are not accurately captured when they are transferred between systems.

To help our customers tackle coding challenges, simplify their workflow, and manage risk, we developed IMO Core, our industry-leading clinical interface terminology.  

IMO Core can help billing and coding professionals streamline the process of transferring diagnoses and codes from the billing summary or EHR into the practice management system. Additionally, IMO Core helps maintain the clinical, diagnostic, and coding integrity of claims that originate from a different EHR system to help billing and coding professionals easily navigate through interoperability challenges. 

With IMO Core you can:  

Document more credibly

  • Maximize reimbursement by easily capturing secondary conditions
  • Reduce denied claims with accurate, specific diagnosis terminology
  • Increase Medicare Advantage reimbursement by identifying all HCC diagnoses and codes

 

Operate more efficiently

  • Quickly and accurately find and document diagnoses that are mapped to appropriate codes
  • Save time with diagnoses and codes that are automatically updated by IMO subject matter experts (SMEs)
  • Ensure accurate billing and coding with maintenance-free terminology that is always current 

 

About Intelligent Medical Objects

At IMO, we are dedicated to powering care as you intended, through a platform that is intelligent, intuitive, and intentional. Used by more than 4,500 hospitals and 500,000 physicians daily, IMO’s clinical interface terminology (CIT) forms the foundation for healthcare enterprise needs including effective management of EHR problem lists, accurate documentation, and the mapping of over 2.4 million clinician-friendly terms across 24 different code systems. 

We offer a portfolio of products that includes terminologies and value sets that are clinically vetted, always current, and maintenance-free. This aligns with provider organizations’ missions, EHR platforms’ inherent power, and the evolving vision of the healthcare industry while ensuring accurate care documentation and administrative codes. So, clinicians can get back to being clinicians, health systems can get reimbursed, and patients can more easily engage in their own care. As intended.

To learn more please contact Will Caldwell or visit: https://www.imohealth.com/schedule-a-demo/

  1. https://www.changehealthcare.com/blog/wp-content/uploads/Change-Healthcare-Healthy-Hospital-Denials-Index.pdf
  2. https://www.meddata.com/blog/2017/10/26/medical-billing-statistics/

 

If you enjoyed this piece about reducing denials, be sure to read more informative articles from EZClaim and our partners.

Free MIPS Compliance Webinar

Free MIPS Compliance WebinarJoin Health eFilings, the national leader in automated MIPS compliance for a free educational webinar on what you need to know about MIPS and what you can do now to optimize your score with minimal resources or time on your part.

Session Title: MIPS Compliance: What to do now to avoid penalties and maximize revenue

Overview: With the end of the 2019 MIPS Reporting Period and the start of the 2020 Reporting Period, it’s clear that the stakes have been raised yet again making it even harder to avoid significant penalties. The MIPS program is even more complex than it has been in the past, further increasing the stress, burden and financial risk to providers like you.

Even though the 2019 Reporting Period is over, there is still an opportunity to avoid an automatic 7% penalty for non-compliance. And its never too early to learn more about MIPS and what you can do in 2020 to maximize your Medicare reimbursements.

By attending the webinar, you will learn:

  • How to avoid the automatic penalty for the 2019 Reporting Period
  • The elements of each of the four MIPS components and how they apply to you
  • The complexities of each category and how to navigate them to optimize your MIPS score
  • The importance of starting to capture the required data now to earn MIPS points for 2020
  • The fundamental and critical differences between reporting methodologies

 

Day & Time: Thursday, January 30, 2020, from 1:00 – 2:00 pm EST

Presenter: Sarah Reiter, Vice President Strategic Partnerships of Health eFilings

Presenter Bio: Sarah Reiter is the Vice President of Strategic Partnerships with Health eFilings. Health eFilings is a national leader in automated MIPS compliance and data management. Health eFilings’ proprietary, cloud-based, ONC certified software is the most effective and efficient reporting methodology as it automatically extracts, formats, benchmarks and electronically submits quality measure data to CMS so providers avoid significant penalties and earn maximum reimbursements.

Register today for this free informative webinar to learn more about MIPS Compliance. Be sure to follow us on Facebook and/or LinkedIn to keep up with all the latest from EZClaim.

Why Do I Have A Balance? – Patient Payments

Patient PaymentsPatient Payments – Written by Stephanie Cremeans of EZClaim

Why do I have a balance? The golden question regarding patient payments every physician’s office staff member dreads beginning January 1st. Unfortunately, your patients are not usually savvy when it comes to the nuts and bolts of their contract, and they are frustrated. They thought their plan was good, but now they have a bill.

 

 

68% of patients failed to fully pay off medical bill balances in 2016, up from 53 percent in 2015, and 49 percent in 2014. This number is expected to climb to 95% by 2020

Source: Patients May be the New Payers, But Two in Three Do Not Pay Their Hospital Bills in Full, TransUnion Healthcare, June 26, 2017

So here we are, in 2020. Let’s make sure your office is equipped and able to collect patient payments for services rendered rather than becoming a part of this scary statistic.

Begin with the basics. Make sure that your staff understands these key terms and is comfortable explaining them to your patients.

Deductible – The deductible is the amount the patient has to pay for covered services before the insurance plan pays. Some insurance plans will apply an office visit to the deductible, others will not. Family plans typically have an individual and family deductible.

Copay & Coinsurance – These are both the portion the patient will be responsible for after their deductible has been met. Copays are a set, flat fee. Coinsurance is a set percentage that the patient will pay.

Max Out of Pocket – This is the limit of what a patient will pay for covered services within a plan year. Again, on family plans, there may be an individual max and family max.

Keep in mind your staff will not know the details of your patients’ plans, nor should they be expected to! In the ever-changing world of health insurance, our patients need to become better consumers. So just being able to explain these key terms and why they create a patient balance will help them become better insurance plan shoppers!

Use your tools. Look into using Integrated Eligibility (available through your billing software and your clearinghouse). This will allow your staff to check remaining deductible balances, copay and coinsurance amounts with the click of a button. These results allow practices to confidently collect at the time of service rather than spending time and money on sending statements and working collections after the visit.

Create a plan and stick to it. Use this time to review the efficiency of your patient collections plan. Are you using an outdated plan or policy? Have you considered offering payment plans to patients with an HSA card kept on file? Make sure that your employees understand how important patient collections are to the practice, educate them on the plan and support them when they hold patients accountable to the patient collections policy.

For more information on how EZClaim can help you with this journey, schedule time with our sales team. Ready to get started? Download your free 30-day demo today!

Need Help With Your To-Do List?

Need Help With Your To-Do List?

Need help getting your To-Do list done? We have you covered!

With 2019 nearing its close, now is a great time to evaluate your revenue cycle management
and look for areas of improvement in the coming new year. Make 2020 the year you put the
focus back on your patients by automating your revenue cycle and improving your bottom line.
The best place to start is by ensuring you get your To-Do list done early!

Making the list is just like a New Year’s resolution: Easy to do but hard to complete without a
partner there to support you. The right solutions should be at the root of your strategy. EZClaim
and TriZetto Provider Solutions (TPS), a Cognizant Company, have the tools and support to
make a difference in your practice and can help you get through the list:

  1. Go digital – Check!
  2. Improve denials management – Check!
  3. Get paid faster – Check!

If these challenges are at the top of your 2020 To-Do list, get in touch with our revenue
cycle experts now to find out how we can help you check them off your list and make sure you
are ready to recoup all that you are owed in the coming new year.

In the meantime, download our infographic with the details of the financial and operational
benefits of getting your To-Do list done early this year.

Getting Claims Right the First Time

Getting Claims Right the First Time

Getting Claims Right the First Time. Contributed by Timothy Mills, Chief Growth Officer, Alpha II, LLC

The numbers are staggering. Industry averages report that nearly 20% of all claims are denied, rejected or underpaid. And considering the cost to rework claims — not to mention even higher appeal costs — as many as 60% of returned claims are never resubmitted. 

With figures like these, it’s no wonder medical practices continue to face intense financial pressure. As negotiated reimbursements stagnate and operating expenses like rent and salaries continue to increase, the struggle to maintain steady revenue becomes even more crucial. For many practices, conducting reviews of their revenue cycle workflow would show gaps in their claims process. The good news is – these gaps can be bridged with the help of emerging technology. 

With a saturated market of coding, billing, and compliance solutions, how do you begin to find the right technology for your practice?  When trying to improve revenue integrity, it is important to understand exactly what vendors offer. For example, consider the term “first-pass claims rate,” which is still used by some healthcare IT vendors to represent the number of claims initially accepted by payers. But what is often overlooked is the number of those initially accepted claims that will be denied or underpaid. A better question would be – what percentage of claims are getting paid the first time they are submitted?

The fact is, practices that do not employ the latest clinical coding and editing tools within their revenue cycle are leaving money on the table. This is revenue that is rightfully theirs but is being pursued at high, incremental costs. It’s time to rethink traditional denials management practices, move beyond “first pass claims rate,” and embrace the future of denial prevention.

It’s your money. Go after it.

Still not convinced that investing in emerging clinical coding and editing software can save your practice money? Let’s see what relying on traditional denials management methods might really be costing you. 

Each rejected, denied or underpaid claim represents earned revenue your practice is missing out on. Based on industry reports, the average cost to rework a claim has been pegged at more than $25, and appeal costs can skyrocket to over $100. It’s estimated that as many as two-thirds of all denied claims are recoverable. But practices often weigh the reimbursement amount of a claim against the cost to rework or appeal that claim. For smaller claims, many decide it just isn’t worth the effort, which is why getting claims right the first time should be the ultimate goal.

So how much are practices losing by simply correcting and resubmitting denied claims using traditional denial management methods? Let’s look at an example using figures from an actual mid-sized specialty practice. This practice submits 1,900 claims a month and the average claim is $150. They have a better-than-average denial/rejection rate of 10 percent. Even with that lowered rate, this practice is losing roughly $28,500 a month to unresolved denied claims. If two-thirds of those denied claims are recoverable, they stand to recoup $19,095 in reimbursements after the claims are corrected and resubmitted. Factor in the cost associated with reworking denied claims using the industry average of $25 per claim, and this practice is spending $4,750 in administrative charges alone to recover their own revenue. This brings their actual recovered revenue down to $14,155 per month or almost $170,000 annually.  Investing in a comprehensive clinical coding and editing solution is still cheaper than what the practice spends per month when reworking denied claims. 

The Alpha II Solution

Are you ready to submit precise claims the first time?  Contact Alpha II, a leader in revenue cycle solutions. Our comprehensive clinical claim editing solution, ClaimStaker, covers the entire continuum of care, verifying claim data from the payer’s perspective and allowing for corrections prior to filing.

Check out our Denial Impact Assessment Calculator to see what your denials really cost your practice or contact us today for a free personalized Claims Assessment. See why ClaimStaker does more than clear claims. It gets claims paid. 

We work hard to update our blog to keep you up-to-date on what’s happening in the field of medical billing software. If you have a topic you would like to see discussed, please contact us.

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Ste 200
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877.650.0904

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