Your patients love you. Your staff is the best in town. Your practice is busy and growing. So why do you still have cash flow issues?
Establishing an effective accounting system and billing cycle is the key to keeping money flowing into your practice. It translates into retaining good employees, expanding your practice, and keeping patients happy.
In my years of running a successful medical billing company, I’ve found a few simple tips that are often overlooked, but can have a big impact on your practice’s bottom line:
Tip 1: Develop, update, and follow your billing procedures handbook
If your billing associate calls in sick tomorrow, could anyone in your office, including you, easily access a procedures handbook that outlines step-by-step your billing process?
Your billing procedures handbook should be an accurate, up-to-date guide to your practice’s billing system. Ask yourself, “How much crucial knowledge about my practice is currently held only in someone’s head?” If you don’t have your processes written down, regularly updated, and followed, I can guarantee that you will lose track of your cash flow, often within days.
Tip 2: Cross-check open claims against scheduled appointments
Your billing team must make sure an exam has been documented and a claim created for each patient on the schedule. Reviewing the previous day’s schedule should be the first task each morning. Don’t let a “no show” become a “never show.” All the “no-shows” should be contacted to reschedule their appointments.
Tip 3: Solve non-pay and rejected claims the day they come in
Every unpaid claim runs the risk of never getting paid. Each lost payment benefits the insurance company and drags your practice in the red. When you build your billing procedure manual, the second item on the daily workflow should address and resolve unpaid claims.
Tip 4: Inform patients of benefits and payables before their visit dates
This is both a good financial and efficient business practice. Don’t just rely on an automated recorded reminder. Have a procedure to inform patients of payment, referral, and authorization expectations before their service date.
Build this into the practice culture. None of us like surprise billing, especially now with increasing deductibles and decreasing coverage. Administrative errors are the easiest way to lose a star (or two) in your patient rating.
Tip 5: Verify patient coverage plans beforehand.
Insurance plans are like an alphabet soup: PPO, HMO, POS, EPO, HDHP, HSA, not to mention primary, secondary, tertiary, and many others. If you treat patients without identifying their exact insurance plan and coverage, and most importantly, without verifying whether you participate with the particular plan, you run a great risk of not getting reimbursed for your work.
Are there more practice guidelines to consider? Absolutely. But just addressing these five tips will significantly improve your cash flow and reduce your billing errors, resubmissions, and rejections. After all, it’s your money. You earned it. Isn’t it time you got it under control?
Tip 6: Finalize exams and submit claims on time
If exam notes aren’t finalized within 24 hours of the visit, a daily reminder must go to the provider, especially if that’s you. If this issue still persists, your biller and manager must meet with the provider (or you) to solve this issue. Any delay in completing exams increases the risk of losing vital health information.
Documenting visit notes for treatment on the day of the visit is part of providing good healthcare and building a strong patient base. You will avoid trouble with insurance companies and patients while building increased practice earnings.
Tip 7: Verify claims are clean before submission
Before submitting any claim to insurance, your billers must audit the exam notes. The claim itself is just a single sheet of paper with concise information, mostly with codes and numbers, which tells a detailed account of the visit from the first phone call to the end of the visit. Before submission, make it a routine to ask, “Do I have the proper documentation to back up the claim?”
Tip 8: Every test should have supporting documentation of need
Every plan has its own coverage policy for diagnostic testing. Before your practice does any test on the patient, be sure the physician, technician, and biller first ask, “Who is paying?” Your billing team must maintain current Local Coverage Determination (LCD) lists for tests performed at your practice.
No matter how much you feel it’s necessary to perform a test if it is not covered under insurance LCD, it will not be paid. In cases where you feel a test that’s not covered is absolutely necessary, consider getting a waiver/ABN signed by the patient and clearly explain why it’s important for their health.
Tip 9: Review your insurance aging report regularly
Insurance Aging must be reviewed on a fixed interval for two purposes. First, to make sure correct (or corrected) information has been sent, related notes are in the patient’s file and a corrected claim (if needed) has been submitted. Second, regular review of insurance non-pays will allow your billing team to find rejection patterns and avoid the same mistakes in the future, and bring in payments for all claims. Your goal is to get all claims paid under 60 days.
Tip 10: Stay current on HIPAA and insurance company rules and requirements
Going through an insurance audit is a very painful process. You must keep updated on the rules and regulations of all insurance, as well as federal and local government laws. Rules and laws are updated throughout the year, so do not take the printout from last year for granted or apply one company’s rules to another. Stay current on insurance rules, they may change frequently. Failure to run your practice according to HIPAA guidelines is both unacceptable and a malpractice risk. Your own compliant plan should work as an owner’s manual for everyone in the practice.
Closing Thoughts
Improving cash flow in your medical practice starts with clear billing procedures, timely claim submissions, and compliance with insurance and HIPAA regulations. Maintaining an updated billing handbook, resolving unpaid claims immediately, and verifying patient coverage upfront are essential steps.
Regularly reviewing insurance aging reports and staying informed about regulatory changes will help avoid delays and denials. By staying organized and proactive, you can ensure a steady revenue stream, retain satisfied patients, and support the growth of your practice.
