Much in the same way no one instrument is the most important in an orchestral piece, so no one aspect of the billing process is the most important. The stops along the billing route all contribute to the steady flow of revenue into the practice. Consider the standard billing process, which includes: timely locking of the visit note, which contains documentation to support all the services rendered; prompt processing of a clean insurance claim, preferably daily, but certainly on a frequent schedule; quick follow-up on denials of payment, which should be rare because your billing procedures are spot-on; and speedy payment posting so you can bill patients for their share. Did you catch the many ways we said “fast?” Billing must be efficient and prompt. Let’s look at these individually:
Locking the note. The widely accepted guideline is to have a note locked within 72 hours of the visit. This often includes time to have a coder review the note for any glaring issues that must be corrected before processing the claim. We periodically encounter practices with big backlogs of open notes for which claims cannot be submitted. We recommend a review of the practice’s open notes for each provider no less than weekly with action as warranted.
Documentation review. As we know, the adage, “If it isn’t documented, it didn’t happen” can have a big impact on the payment of claims. Medical necessity for the services received must be clearly evident on the note. In addition, a proper assessment must be charted, and there must be documented evidence that billed procedures like venipuncture, EKG performed & interpreted, injections, etc. were indeed performed. Outsourced billing services where the practice sends only a superbill can result in issues since the biller is not reviewing the documentation on the “front-end.” This can mean recoupments and recoveries on the “back-end” if the note isn’t sufficiently descriptive.
Daily processing. Two arguments can be made against daily transmission of claims and we reject them both: we don’t have enough billing in order to process claims daily and we have too much billing to transmit daily. Hogwash! (a technical consulting term LOL) Why would you not want to get the ball rolling on a payment as quickly as possible after rendering the service? Delaying billing can lead to revenue disruptions. Emergencies happen. Your biller is in an accident or you experience a critical staffing shortage – or maybe, we’re hit with a pandemic – and the next thing you know, your claims are past the timely filing deadline. Get in the habit of processing claims on a daily basis. And if daily is truly impossible, shoot for two to three times per week, every single week.
Action on denials. Your billing processes may be pretty flawless, but denials of payment can happen through no fault of your biller. The important thing is to check for them as often as possible and/or on a regular schedule, such as weekly, depending on your volume of denials. Next step is to commit a day or portion of the day – maybe it’s the last hour – to researching the issues surrounding a denial. Some will be easy to fix while others may take calls to the insurance company and additional time-consuming tasks. By devoting a set amount of time to denials on a daily basis, you will be more likely to turn them around quickly so you can receive your payment. Managers should periodically spot-check that denials are being worked. After all, your biller may be stuck on how to fix the error, set the denial aside to figure out later…. and never come back to it. If you’re not checking, how would you know about the lost revenue and the biller’s knowledge gap?
Payment posting. The last two aspects of the billing process start with posting payments. This tedious end of the line task is sometimes delayed in favor of processing new claims, which is a mistake. The prompt posting of payments, firstly, stops the clock on the accounts receivable. In another blog, we discussed the Billing No-No of neglecting the A/R. Remember that the A/R aging calculates the time a claim is outstanding, so by posting payments quickly after receipt, you will more accurately reflect the time it took to complete the cycle on that claim. The second reason to post quickly is to determine whether additional monies are owed by the patient… which brings us to the very last stop on the billing journey: patient statements.
Patient statements have to wait until payments are posted. You want to bill your patients as quickly as you can after the visit, so as soon as your payment reveals any patient responsibility, a statement will be generated in your next batch of patient bills. Speaking of which, patient statements should be sent according to a set schedule, which for small practices is probably monthly. If your volume of statements is high, consider sending 25% each week so as to spread out the work (which includes answering patient calls about the balances) and also maintain a steady revenue stream.
Remember how in the opening paragraph we stressed the speed with which these activities must take place? Add to that the regularity. Resist the urge to focus only on new claims and be sure to carve out portions of the day or days of the week where your billers concentrate on the other aspects of the billing process. This will result in a billing cycle that resembles a most harmonious symphony.