Billing for your medical clinic services continues to grow in complexity. There are so many data entry touch points where a medical claim can go wrong and dealing with issues as you find them is just a temporary band-aid. Your front end information collections must have a periodic and thorough review. Having your information collection process, training, documentation and checks and balances under regular scrutiny can help improve not only data integrity, but overall clinic performance. The quality of your review will equate to dollars or delays on the back end. 
Poor data collection processes will show up in higher than expected accounts receivables. This impacts clinic cash flow and the amount of time staff spend fixing problems instead of working appointments. Even the best billing office won’t perform optimally with data entry errors or missing data. Each incorrect data element will need to be identified, correct information gathered, and then reentered and resent for payment. Delays in payment can move your days of sales outstanding from 32-34 to 45 or 50 days – not good when its time to pay your clinic bills.
But error free claims don’t happen magically. It starts with the first phone call and all the way through to patient billing. A few basics must be covered during the initial call and again at the front desk check-in:
- Confirm your patient with date of birth and name
- Update patient address and phone number
- Update insurance information
- Validate insurance coverage for the clinic, physician contracting, and services requested
- Review any outstanding balances for patient and family
- Explain expectation of payment for co-pays, co-insurance and deductibles
With some appointments made 30 days or more in advance this double check is even more critical. Changes may have occurred with employment status, insurance coverage, etc.
Another important element of the front desk interaction is consistent policy review with patients. Having absolute confidence that every patient who is served by your clinic has been provided the same information is invaluable. Policies regarding insurance coverage, cancellations, payments, and collections should all be reviewed on the day of the appointment. This is obvious information for a new patient, but what about returning patients? Providing staff with training that ensures they revisit policy for every appointment can help. For example, reviewing the patient’s policy sign-off date, always giving an opportunity for questions, and offering a copy of clinic policy can ensure patients understand clinic expectations.
Moreover, talking about a process is very different from having it written down and trained. Having a conversation with your staff prior to the training to learn about their challenges and providing strategies to overcome them is an important step in process building. Here are several areas that pertain to the phone call and front desk that should be reviewed with your clinic staff:
- Where are the checks and balances for data entry from the phone to the front desk to the billing office?
- If a data entry error occurs when will it be caught and how fast can it be corrected?
- How many systems does an initial data entry error impact and how do we ensure new information is updated throughout our systems?
- What are the steps to verify insurance eligibility, correct data entry and authorization requirements?
- What is the patient’s responsibility if coverage is not available and how are they informed?
- How and when are co-pays, co-insurance and deductibles collected during an appointment?
- What are our clinic payment expectations and what should staff do when someone cannot pay or refuses to pay?
- Has the visit been coded to maximize reimbursement? Have the appropriate modifiers been added?
- Does the documentation support the level of coding used? How are physician coding and documentation changes requested and how are unbilled visits monitored until completed?
Utilizing a process flow sheet can provide a means of breaking down a complex process into simple steps with checks and balances. Getting your procedures written down, training developed and a check-off for cross training every new employee gets the process and policy from paper to implementation. Once the processes are in place, reviewing complaints, denials or errors with staff as they occur and identifying if the processes address the issue (or not) will drive the continuous process improvement.
In the end, everyone will benefit from improved data entry and less rework. This include patients, front desk, physicians and the billing office. The bottom line will improve along with it lessening your overall accounts receivable and days sales outstanding. As medical clinic services billing continues to grow in complexity a band-aid just won’t do it. A thorough review, regular process updates, and cross training is the way to go for your clinic.