Before considering this question, let’s recap the process before it’s time to send patients a financial statement for the amount that is her responsibility. A patient is responsible for a service usually when her insurance pays nothing or a portion of the fees. Before a visit or a procedure, it’s imperative to check a patient’s eligibility and benefits. We find several practices/ surgery centers that do not have the bandwidth to complete this task and the practice management system is not equipped to complete this task automatically.
If that’s the case with your organization, sign up with independent eligibility verification services – remember that it’s never fully automated. Checking a patient’s eligibility decreases the risk of the claim being denied by insurance. After the service is performed, it’s important to submit charges within 24 hours of service – the longer it takes to submit charges, the greater likelihood that it may be denied. After receiving payments, it’s important to post payments in the practice management system immediately. It’s at this point when we know what a patient is responsible for.
The answer to the question above (should you be send statements daily or in bulk?) is simple: send them daily. At the outset, collecting money from patients after a service is one of the most difficult parts of the revenue cycle. It gets a lot more difficult to collect with every passing day from the date of service. Often practices make the mistake of sorting patients alphabetically and submitting statements in that order. This process does not take into account the amount in question or even the likelihood of getting paid from that patient. Ideally, a practice or its billing company must use analytics to determine the likelihood of getting paid and send statements accordingly. If a patient has gone through an endoscopy under a failed insurance plan then the patient must be made to pay the very day of service. Consider if a patient is a repeat offender or if she has occasionally lapsed. What type of insurance plan history does the patient have. While it’s the responsibility of the center to bill all patients, it’s also important to remember that not everyone will respond or even pay the same way. If she is routinely missed payments or ignored them, bill immediately. The administrator or system must determine this as soon as a patient is provided service – this decision must extend through the process and trigger a statement and type of statement once payments are posted.
In summary, it’s important to think about the process around patient accounts receivable differently and not treat all claims and all plans equally after a point. It’s also important to work on statements daily and send them. On a future blog post, I’ll explain methods of sending statements and what must happen after a statement is submitted – when and whom should you be calling?
By Praveen Suthrum, President & Co-Founder, NextServices.