5 Tips for More Effective Physician/Dentist Billing

Effective Revenue Cycle Management Starts w/ the Basics
Avoid Billing Pitfalls
Effective Revenue Capture Requires Diligence/Discipline
By Kevin Williams, Managing Director Claim Resolutions

Many people believe that doctors/dentists sit around on the golf course making millions. Today’s reality is that even well respected physicians/dentists often find it difficult to cope with the complexities of the constantly evolving healthcare reimbursement process. Unlike most if not all other industries where invoicing is standardized, healthcare/dentistry billing is a complex process of hoops and potholes conducive to a high level of less than desirable results for the business owner. Many highly trained physicians/dentist find it difficult to turn a profit especially while covering the cost of education. The arduous and detail oriented task of healthcare/dentistry revenue cycle management requires a focused approach with the experience to see through the fog and guide the revenue to the bottom line of the practice.

Effective Revenue Cycle Management starts with the pre-visit process and requires diligent attention to detail at both a basic and complex level. Even one small mistake will result in delay if not outright denial of payment. Although patient care is the purpose and focus of any successful practice, effective revenue cycle management is an absolutely essential component that must not be overlooked. The following is a short list of tips (in chronological order) that when followed closely, will result in an immediate boost to your practice’s bottom line.

• Pre-visit Patient Registration- Financially successful practices in all specialties have at least one thing in common: effective pre-visit patient registration procedures. Prior to a patient stepping foot in the office, front office staff should have completed all patient registration documents and insurance eligibility verification. Once insurance benefits have been verified, staff members should contact patients with an appointment reminder, as well as to set appropriate expectations for patient financial responsibility (co-pay, deductible, co-insurance).
• Efficient Patient Check-in Procedures- Upon patient arrival, staff members need to quickly and effectively present all patient waiver and intake forms for signature and make a copy of the patient’s insurance card. At this time staff members must collect appropriate patient payment. Allowing patients to see the doctor/dentist/provider without collecting patient responsibility is a sure fire way to loose earned revenue and create more work for the back office billing team. Collect all patient payments prior to rendering services and your practice will save time and resources while capturing more of your hard earned revenue.
• Timeliness- “Time is of the essence” does not even begin to describe the nature of healthcare/dentistry billing landscape. “Timely Filing” requirements/deadlines are absolute killers when it comes to insurance claims and patient collections. The easiest denial for an insurance carrier to uphold is one for “Timely Filing.” Notification of admission (when required), obtaining authorizations, claims submission, and filing of appeals with insurance carriers all must be done in accordance with strict timelines (ranging from 30 days to 1 year).
• Follow-up and Denial Management- One of the greatest areas for concern in most practices is the effectiveness of claims follow-up and denial management. This is where key staff members and third party administrators really earn their keep. Claims follow-up requires a truly relentless approach in order to optimize results. Billing team members should contact insurance carriers repeatedly when necessary to effectuate proper processing of delayed and denied insurance claims. This approach demands tenacity from your billing team as the insurance carriers will frequently say/do anything necessary to keep the money on their balance sheet not yours. Develop set guidelines and systems that empower your staff to effectively battle insurance carriers for your hard earned revenue.
• Patient Billing- The most important aspect of the patient experience is the provider-patient relationship. The bond formed between care giver and patient can last a life time. This is why patient billing must be handled in an effective, professional, and compassionate manner. First and foremost, as mentioned previously, setting appropriate expectations with regards to the patient’s financial responsibility is the building block of successful patient collections. Upon discharge/completion of services rendered, the process of invoicing for any/all remaining patient balance should be handled immediately upon adjudication of the insurance claim. Patient statements should be mailed at least once per week in order to effectuate timely payment receipt. Follow-up on outstanding patient balances should be handled in a serious yet compassionate manner. This will result in timely payments while maintaining the all-important provider patient relationship.
Effective Revenue Cycle Management is a difficult task that has very little to do with the technical work of providing quality healthcare, but it is an absolutely crucial component of every success practice in every specialty. After all your hard work in school and in building your practice, you owe it to yourself! Follow these simple guidelines and watch your bottom line grow.