Collect More Reimbursement by Correcting This Big Issue

Following up on your claims is just as important as submitting them.


As ophthalmologists face the prospect of changing reimbursement amounts in 2018 and the potential issues that MIPS will bring, practices can’t risk making any mistakes that threaten your income. To ensure that your billing processes are set up to collect every penny, read on for several expert tips that will help you bring in more of the cash that you deserve.


Monitor Every Claim You File

If you do nothing else to tighten up your billing process, at least take this one key tip to heart: Pay attention to what happens to every claim you submit. Follow the claims through the submission and payment processes so if a claim is delayed, you can follow up quickly.

If you bill the claim and forget about it, you’re likely to fall so far behind in your accounts receivables (A/R) that you may end up with a mountain of claims that haven’t been paid. “When we go in and start working with a new practice, we see the same problem over and over again that causes practices to fall behind in their A/R, and that’s claims follow-up,” says Kelli Bryant, administrator with JKK Medical Billing Services, LLC in Lincoln, Neb. “Claims are rejected or denied, but no one appeals,” she says. “The claims sit in a pile and no one addresses them. The claims may even be sitting in the clearinghouse rejected.”

Set a reminder: Try placing an event reminder on your Outlook or Web calendar every week that reminds you to check all accounts receivable for the past 30 days. Print a report, and go online or call to check claim statuses.


Start With Clerical Issues, Follow Through With Aging Reports

You can improve A/R with steps that start at your practice and go all the way through the billing process, advises Laurie Troemel, CPC, CPMA, operations director with Medical Practice Management Services. She reminds practices to verify eligibility and patient demographics to ensure you have no errors — either clerical or via other issues — in your files regarding the patient’s name, insurance number, address or other problems. You should also verify benefits and collect copays upfront, Troemel says.

Your next step is to electronically submit clean claims within one to two days of services being rendered, she advises. Then, “request direct deposit (EFT) of payments and electronic remittances (ERA) for faster receipt of payments and payment posting. Denials should be worked immediately after posting the remittance.” After that, you’ll develop A/R aging reports to quickly identify potential problems with specific payers.”


Know When to Write Off Patient Balances

In some cases, practices may find that they have patient balances sitting around for months without collecting payment on them. When this happens, you have a few options, one of which is to write off the balance. But knowing when that’s the right move can be tricky.

“Practices should have a universal protocol for this situation so they always follow the same rules for every patient,” Bryant advises. “Writing off balances should be a last resort, but every office has a different policy on this, depending on the size and the relationship with patients -- but you have to have some policy. Follow your guidelines with every single patient.”

Some questions you may want to ask yourself when considering a write-offs policy include whether the patient balance is less than the cost of printing and mailing a statement, Troemel advises. Also, ask yourself whether your collection agency has a minimum referred balance, whether the balance is definitely uncollectable, and if the patient is indigent or a hardship case. In addition, she says, investigate whether writing off balances that have been processed to patient responsibility violates any payer contracts.


Reprinted with permission from The Coding Institute

MPMS processed over 450,000 encounters last year.