Bringing Others Into
The Process
I feel for you, patient accounting directors, office managers, supervisors, billers, registration folks, collectors,
etc. In today's tough
healthcare economy, upper management keeps trying to find ways to reduce staff yet increase productivity. Not that life was simpler
when everything was billed on paper, but it's harder these days to get a bill out correctly because most of the time we don't even see the
claims. All these front end systems that were designed to help us get claims out the door quicker have resulted in our having to try to
dedicate more time to the upfront processes of registration, charge capture,
and medical records coding.
What happens, though, is that patient accounting ends up trying to fix everything on their own. Error reports are received by patient
accounting; denial reports are worked by patient accounting; late charge reports are worked by patient accounting. The great majority
of what shows up on these reports is nothing that was initiated by patient accounting; that is, the corrections being made are the result of
something that took place in another area that hits an edit and throws the system into a frenzy that shows up on some report.
Even in physician's offices, where most of your billing may still be on paper, you face some of the same issues without all the reports. You
receive claims back non-paid, with denials you have to research, and many times you figure out, if you're good, that the problem wasn't with
how you sent out the bill, but how it was coded, or what was reported as the procedure or place of service.
I have found in many institutions that patient accounting handles the entire process for all the above mentioned reports and issues.
Oftentimes, they don't think to involve those departments throughout the hospital that may be creating the problems they're addressing.
Sometimes they're unsure of who to go to; information sharing throughout hospitals and medical facilities is pretty bad. Many don't feel they
have the authority to take the initiative and get it resolved. And some others have tried, but having quite figured out how to get the ideas
they're trying to convey through properly, therefore they're either ignored or misunderstood, and nothing gets done.
It's imperative to involve other departments in the process of what, in essence, is the charge capture and billing process. Any processes
that can be fixed or addressed up front, before the bill leaves the facility, shortens the length of time claims will be paid, which helps to
increase cash flow and lower outstanding receivables. Any processes that can be set up to more quickly address back end errors or denials
does the same thing.
Below are recommendations for how to get others involved in the process to help your facility or organization to improve its cash collections
in these situations:
- Do a full review of the reports and separate the errors, late charges, or denials by the departments that are ultimately responsible
for them. You need to have your information set up to make it easy for you to present it to someone else on the back end.
- Set up a meeting with your chief financial officer or whatever the position is called and show them the results of your review. You will
find that if you get the financial people on your side it'll usually take care of any possible negative issues you may encounter on the back
end with the clinical people.
- Request a meeting with the proper representative from those departments so you can show them your issues. I always feel it's best
to shoot for the top and then let them make the determination if someone else is better suited to talk to you.
- Don't go into the meetings with an accusatory tone; offer it more as an exploratory matter of concern, and attempt to illicit solutions
from them. Have some ideas of your own, if possible, on how they would be able to help eliminate some of the problems you may be experiencing.
- Try to find ways to have more charges coded with the modifiers up front instead of having to try to do it on the back end. This is
especially problematic in those errors where an ABN has to be given to a patient, whether or not they request the
charges in question be
billed or not. Patient accounting or medical records must have some process where they know by the next day all patients for whom ABNs
have been given so they can put modifiers on before bills drop, instead of waiting for claims to be returned to them as denials.
- Establish meeting time frames to get back together with each of these department representatives to go over new and existing issues.
In time, if the process is working, there will be fewer issues to talk about, and the meeting will move along quicker.
Everyone benefits from a sense of shared cooperation when it comes to the cash collections process. Involving other departments not only
improves cash and reduces receivables, but it also shows other departments throughout your facility just how important what you do it, and
what it means to them.
