Your medical practice can’t operate without receiving money for services rendered, whether from insurance company claims or patients paying out-of-pocket. Sometimes, over time, this process can feel faceless and frustrating, especially if payment isn’t being received in a prompt manner.
When it comes to patient collections, you need to first understand the basics of billing and collections procedures within the medical industry.
What Are the Typical Billing and Collections Procedures in a Medical Practice?
There are a handful of steps that must happen before a patient’s visit is translated into a bill, including:
In order for an appointment to happen, the patient must schedule a visit and provide their details to the front desk staffer. These details include patient demographic information, such as their name, address, social security number, etc., and the reason for the visit.
This is a crucial part of the patient experience because this interaction gives them an impression of your medical practice and can be the cause of a tremendous headache if information is entered incorrectly. Be sure your administrative staff double-checks the spelling of names and street addresses so you can avoid having to follow up with the patient.
Insurance Eligibility and Verification
Verifying patient insurance information and their eligibility for the visit or treatment is essential for moving forward with the patient’s appointment. This should occur shortly after the patient provides this information and the reason for the visit. Patient insurance plans can differ from state to state, from provider to provider.
Verifying that the patient’s insurance carrier has authorized their treatment at your medical practice is incredibly helpful for your administrative staff and for the patient—if it turns out that services you provide aren’t covered by their insurance plan, then the patient should be notified so they understand their options for paying out-of-pocket or finding another practice where the work or service is covered.
Patient Check-In and Appointment
When the patient arrives at your medical practice for their appointment, it’s best to confirm their information and insurance card with a personal ID.
For example, their insurance plan or carrier might have changed between the time they made the appointment and the actual date of visiting your office, so it’s imperative to verify their information.
Additionally, if you’re able to, provide the patient with their copay or total bill before the appointment so they’re aware of the out-of-pocket cost to them.
Medical Coding for the Appointment
Medical coding is one of the most tedious and intensive facets of the patient billing and collection process; this one step has a tremendous impact on your medical practice’s revenue cycle. Whether your medical practice utilizes ICD-10 (International Classification of Diseases) or CPT (Current Procedural Terminology) codes, if they’re inaccurate on your insurance claim, they’ll be rejected and your medical practice will have to rework them all over again.
This process is incredibly detail-oriented and your practice’s financial bottom line could be greatly impacted by a low number of clean claims. Consider partnering with a medical billing firm to handle this important aspect of your medical practice’s revenue cycle.
Submit Claims to the Patient’s Insurance Company
Once you’re sure that a claim has been accurately coded and has all the pertinent information it needs, your medical practice submits it to the insurance company.
This is typically an electronic process, and it’s important that you promptly submit claims with as much accuracy as possible. If not, your revenue cycle can suffer from delayed claim submissions and having to redo claims submitted with mistakes.
Insurance Processes the Claim and Payment is Reimbursed
When an insurance company’s claim adjusters evaluate the claim and process the codes attached to the claim, payment is reimbursed to your medical practice. If there are errors, either in terms of patient information or medical codes, then the insurance company will return the claim. When this happens, it’s on your medical practice’s administrative staff to rework the claim and resubmit it for payment from the insurance company.
If the claim is accurate, then a medical adjuster working for the insurance company will reimburse as much as contractually agreed upon and send a bill to the patient to cover the remaining balance.
Top Challenges for Patient Collections That Slow the Payment Process
When it comes to patient collections, there can be a few challenges that medical practices face, including:
Inaccurate Patient Information
This is one of the most common challenges for patient collections: the simple spelling of a name incorrectly or miskeying insurance information. Another layer to this is failure to verify the patient’s insurance information at the front desk on the day of the appointment.
At any point, incorrect information regarding the patient can make contacting them impossible and delay payment from insurance companies on behalf of the patient.
Miscoding the Visit
Using the wrong codes on a claim is a sure way to delay payment for services rendered.
If you submit a claim to the insurance company with inaccurate codes, then your staff will have to follow up on the claim by re-submitting it with accurate codes and information. This results in delayed payment and wastes the time and effort of your medical practice staff.
Not Educating the Patient About Their Responsibility
Patients probably don’t understand how the medical billing process works, what role their insurance plays in payment, or what to do if they have questions about their responsibility in the paying process.
Communication is key to address patient education; be upfront about the breakdown of costs to the patient and be open to questions from them about what their insurance covers. By clarifying what the patient’s insurance covers versus what the patient will owe out-of-pocket is a surefire way to streamline patient collections.
How to Make Patient Collections More Compassionate: 3 Tips to Follow
When reaching out to patients to collect payment, keep the following tips in mind to ensure compassion throughout the process:
Maintain the Patient Care Mindset
Once the second or third statement goes unpaid, the patient is often removed from your team’s mental approach to the situation. The potential exists for the person to become a payment. Don’t let that be the case!
Train your medical billing team to remember that billing is the final, loop-closing aspect of the life-saving, disease-preventing care and treatment you deliver in order to help patients be well—not just a bureaucratic exercise in managing income totals.
Remember the Reality
When it comes to collections, the problem typically isn’t a patient’s lack of desire to pay. They’re not ignoring your invoices because they take issue with the total on the invoice; they’re likely not paying because they don’t have the money.
Craft your collections strategy with this in mind, and you can actually help debt-laden patients square up slowly, over time. Educate patients about payment plans they can afford, refer them to resources that can help, and work with them to manage their medical debt.
Reserve Judgments of Patients
In all walks of life, it can be difficult to set aside our expectation that an individual “should” always be able to pay for services rendered to them. With the pandemic continuing, many people are still trying to get back on their feet in more ways than one.
Don’t let judgments over why a patient can’t pay cast a cloud over your collections effort; make sure your staff or medical billing firm communicates options to patients with integrity, compassion, and an awareness that no one knows what it’s like to walk in another’s shoes!
NCG Medical Can Help Streamline Your Medical Billing Process!
The medical coding, billing, and collections portion of your medical practice can be layered with complicated details and stress. Let NCG Medical handle your medical billing and coding to ensure your claims are submitted promptly with great attention to detail!
By partnering with a medical billing firm, you’ll notice an immediate boost to your revenue cycle while you and your team get back to what matters most: connecting and caring for your patients.
For over 40 years, NCG Medical has been trusted with the medical billing process and practice management responsibilities by thousands of practices. Our team of experts has experience in your specialty and can easily work with your medical software. Contact us today to streamline your medical billing and coding!