American College of Physicians: Internal Medicine — Doctors for Adults ®

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‘Show me the money’—by maximizing accounts receivable

From the January ACP Internist, copyright 2009 by the American College of Physicians

In today's tight economic environment, collecting every dime is critical to a healthy bottom line. Since cutting expenses can only go so far, maximizing revenues is a more effective way to make a difference in your practice.

Accounts receivable management refers to how long it takes to get paid and how much you collect on every dollar you are due. So before you start working harder or increase your charges, first make sure your practice is doing a great job collecting payments both from patients and insurance companies.

  • Send out clean claims. Make sure your front desk staff is entering the information correctly in the computer system. Missing data elements or transposed numbers can be costly, and are preventable. Also ensure that the computer system is set up correctly. It is surprising how often making simple changes on the front end can make the back end job of collecting much easier. A promptly paid claim goes in your bank account, not your accounts receivable.
  • Collect copayments and deductibles diligently. If patients pay at the time of service, your staff members can spend their time collecting larger balances or appealing denials. This also saves precious time and money sending out statements.
  • Assign staff to payors. This increases accountability and also allows staff to get to know their assigned payors' policies and develop good working relationships with payor staff. There are no guarantees, but claims processors are people too, and a good relationship can sometimes make a difference when processing an appeal.
  • Use your aging reports as collection tools. Tackle accounts older than 60 days and larger balances first. This will give you more bang for your efforts. If you run the reports by payor, you can quickly see where the trouble spots are so you can provide additional staff training, rebalance accounts, or spot payor issues before the accounts get too old to collect.
  • Review all denials and partial payments for trends. Sometimes the problem is with the payor, but sometimes it can be a formatting problem, a staff training issue or even a coding problem. What are your top-five reasons for denial by payor, by dollar amount and by type? Can you make changes to correct them?
  • Check on claims from about three weeks prior. This allows identification of problems at the clearinghouse stage. If your system says the claims went but the payor didn't receive the claims, then you can resubmit before the claims get too old.
  • Verify patient insurance before visits as often as possible. If anything is wrong in the system, you can correct it when the patient comes in.
  • Pay attention to coding. Know what modifiers are, how they work, and when to use them. Be aware of the covered and non-covered services you provide.
  • Cross-train your staff. This applies to your collections staff to cross-cover payors and also cross-train front desk and billing staff. Everyone has a role in collections and knowing each other's roles can only help by providing cross-checks.
  • Use benchmarks and trends to assess how you are doing. Calculate your days of revenues in accounts receivable and gross collection ratios, both overall and by major payor, on a monthly basis. There will be ups and downs, but is there a trend?

ACP's Center for Practice Improvement and Innovation offers several resources to help with the financial management of your practice. Members can get free downloads of Financial Management Tools, a Billing and Collection Manual, and benchmarking tools such as Practice Management Check Up.

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