Even with the best intentions, medical office receivables can get out of hand – sometimes really out of hand!
Primarily, this is because insurance companies find every reason to avoid paying claims by implementing an ever increasing number of rules that make it almost impossible to submit a “clean claim”. And to add confusion, each payer may have opposite rules for the same procedure and may change the rules midstream. Medicare is notorious for implementing a billing rule retroactively, requiring reprocessing and oftentimes the resubmission of claims.
To track these requirements, the provider needs internal controls and sophisticated (read: expensive) systems to manage these moving targets. With increased rules coupled with decreased reimbursement, the medical office is hard-pressed to hire and retain the expert staff needed to track these requirements. Many times the billing office is wrought with low morale, staff anxiety and skill sets that lack the necessary expertise to perform effectively. These staff related issues are only exacerbated when IT systems do not work as expected or cannot manage the new requirements, when the different areas of the office do not cooperate and when managers throw up their hands in frustration.
What happens next is the snowball effect. You expend all your current resources just to keep your current accounts moving to the payer, believing that in a few days, you will be able to address the aging accounts, where you will find denials, underpayments, increasing patient balances, etc.
However, that day never comes and then the backlog is more than your current resources can handle. This is where hiring outside resources on a short-term basis can help bring sanity to your billing office. This tactic makes more sense than shouldering the costs of a full-time employee. A medical billing office has the expertise and technology to very quickly resolve your old accounts. A/R outsourcing has become common in healthcare as providers look for innovative ways to improve their performance.
Using a medical billing service is effective, but requires good planning and can fail if proper preparation is not taken. You need to prepare the office and staff for the change needed to sustain a normal A/R once the project is complete. The management team must be fully engaged in the process and plan adequate time to implement suggested improvements, continuing day-to-day business at the same time. A revenue cycle consultant is invaluable in this process.
Change is inevitable: one cannot rest on one’s laurels, and neither can any organization. Prepare staff for the changes that are imminent. This includes all staff, not just the billing office. Although the goal is to clean up overdue accounts, the problems causing them to go unpaid come from scheduling, registration and clinical charging (the entire revenue cycle).
Change needs to be communicated often and in different ways. At times, you may feel that you are over communicating – when you get to that point, you are doing it right. Staff are more likely to implement what they know than what they don’t know.
The revenue cycle is the most crucial aspect of managing your healthcare practice. Turning your cash-starved office into a cash generating business takes planning, commitment to change and in many cases the willingness to accept outside assistance. This is no easy task. Many offices have entrenched practices that will not be easily moved. But a practice willing to take an honest look at their revenue cycle, develop a plan for change and commit to implementing the plan will be rewarded with the cash flow needed to thrive.
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On Call Medical implements and manages highly customized, comprehensive and cost-effective medical billing and account receivable solutions proven to dramatically improve the profits, revenues and quality of life for health care providers.
