Who Does What?

With reimbursements getting tighter by the day, changing forms and new claims requirements, this is a good time to review your accounts receivable process to make sure it is operating at its best. Plan any improvements you might need so that your process will function as efficiently and effectively as possible.

• Verification of coverage Benefits must be verified prior to delivery of equipment of supplies. Determine the beneficiary’s deductible amount remaining. Determine the patient’s co-pay amount. Find out what DME max benefits are. Have you verified there is no other insurance?
• Collect money up front If a deductible amount is due, collect it at the time of delivery. If there is a co-pay amount, collect that money at the time of delivery. If the item is not covered, collect money or set up a payment plan at the time of delivery. When in doubt, collect 20 percent up front and put it toward the deductible.
• Policies and procedures Policies for working denials should be written in a policies and procedures manual, and all employees should understand them, agree with them and be trained properly on them.
• Who, what, when and where Who is going to execute the agreed-upon strategies? What specific strategies are going to be employed? When will specific collections efforts be aimed at specific payers, and how will you review the effectiveness of those efforts? Where should collections efforts be concentrated to get the maximum return on your efforts?
• Consistency Collections efforts must be consistent through the company. Employees must be trained and know their performance will be monitored, reviewed and rewarded on a regular basis.
• Persistence Keep a callback log to monitor progress of claims. Get to know the personnel at the insurance company, and build a good relationship with them. Document all conversations as to date, time, patient and content.
• Be flexible Adjust your agreed-upon strategies as conditions and experience dictate. Don’t abandon your game plan because of resistance from employees or payers.
• Prioritize aged AR Figure out the minimum dollar value you will go after, and make a company decision as to what AR amounts you will go after first to get the most money into the company. Analyze your aged AR. Your software can help. Break accounts down by primary and secondary payers, then sort from the highest to lowest amounts owed.
• Top 10 You may find that between five and 15 insurers account for 80 to 90 percent of your total aged AR. Analyze these insurers to find the reasons your claims are being denied. You can identify trends this way, and proper steps can be taken to fix the problems.
• One-hit wonder You may also have insurers on your aged AR report that appear only once but have a high dollar amount. Call these insurers and find out what was done wrong in the claims processing. It could be a rarely used block on the 1500 form that was not filled out or that a different place of service code is used by the insurer.
• Secondary AR These accounts are the most time-consuming to work due to need of a primary EOB for resubmission. If the claim was denied for lack of coverage, transfer AR to the patient portions and bill the patient with the denial EOB attached. Software that produces paper EOBs from ERNs will help speed up processing.
• Assigning work Don’t throw your whole AR at one person. Separate priorities first, such as the top 10 patients who have the most aged AR. You must guide and supervise employees every step of the way, and be available to answer questions.
• Write-offs Don’t be afraid to write off uncollectible debt. Any debt over 180 days is unlikely to be collected. When all else fails, you may decide to turn over portions of aged AR to a professional collection agency.
• Patient pay If possible, collect the patient portion at the time of delivery. Accept credit cards. Get information on close relatives as they may be able to pay the patient amount. Be on the lookout for Health Reimbursement Account debit cards and how to process them.
• Rewards Reward your in-house collectors for performance with certificates of recognition, dinners and checks!

Jane Bunch is vice president, HME consulting, for Atlanta-based CareCentric. A reimbursement specialist, Bunch delivers educational seminars worldwide, helps develop corporate compliance plans and serves as a consultant for fraud and abuse cases. She can be reached at 678/264-4495 or via e-mail at [email protected].