Some folks say the best things in life are free. While that may be true in many cases, in a rehab therapy practice, the best things (like keeping the lights on, for instance) require cash money. But as any practice manager or biller knows, cash flow from paid claims isn’t always consistent. Between fluctuating reimbursements and aging claims, keeping track of your clinic’s revenue can be a full-time job—especially if you don’t have an efficient system in place. To that end, here are some essential guidelines for staying on top of A/R (and getting paid ASAP):
Double-check your patients’ registration info.
Payers reject claims for a number of reasons, but a significant portion of rejections are due to simple—and preventable—typos and input errors (e.g., inaccurate patient information, incorrect modifiers, or missing certifications). The first step toward stopping these rejections is making sure your claims go out error-free the first time. That means verifying patient and insurance information as well as ensuring that the CPT and ICD-10 codes support the services rendered and are consistent with payer guidelines.
Familiarize yourself with various insurance plans.
While you may encounter a wide array of payer types, there are certain insurance plans and payers you’ll encounter frequently—and it’s really helpful to know them inside and out. Here are some other things to consider for each payer, as adapted from this post:
- Does the patient’s insurance plan cover rehab therapy services?
- Is there an applicable copayment, coinsurance, or deductible?
- For deductibles, what amount has been met year to date?
- What network should you use to price claims for this plan?
- Where should you send paper claims?
- What is the payer ID for electronic claims?
- Does the patient have additional insurance coverage? If so, which plan should be primary and which one is secondary?
- Is there a yearly visit limit for rehab therapy? If so, how many visits does the patient have left, and how can you go about obtaining authorization for visits beyond the max?
- Do you need to notify a separate review company of the plan of treatment, and do you need to obtain a specific form for advance notification?
- Does the payer require medical records with claim submissions?
- What is the payer’s timely filing requirement?
- Who should you contact when following up on claims?
Run A/R reports regularly within your billing software.
If you use a solid billing software in conjunction with your EMR (like BMS Billing + WebPT), then you have a myriad of helpful reports right at your fingertips. Specifically, pay close attention to reports that track your current and aging A/R. Ideally, you’ll want the percentage of your aging A/R over 120 days to be as small as possible. But if it’s under 10%, then you’re really kicking butt. That said, it’s more common to see a 12-18% figure for all of your A/R 120 days and above, which is still pretty decent.
As you go through your reports, make a note of each month’s final totals. Use this information to uncover patterns associated with individual insurance companies. Once you’ve recognized payer patterns, you’ll be able to quickly identify when something is amiss. For example, if you know that one payer generally pays in 30 days—but it suddenly jumps to 60 days—then that’s a pretty good indication that there’s trouble afoot. After you’ve identified the issue, have your biller follow up on all of your aging claims that are more than 30 days old to see if this same issue is causing the rest of the delays.
Organize your standard monthly follow-up according to normal clean claim processing times.
As you follow up on aging claims, start with the insurance companies that have the shortest timely filing requirements and work from oldest to newest claims. As you progress through these aging claims, you may find multiple pending claims for a single patient skewing your days in A/R to a higher-than-usual number. (This often indicates that an issue occurred during registration or that the patient is missing a coordination of benefits form, medical records, or a physician’s order.)
Use the right tools.
At the end of the day, tracking aging A/R is all about staying organized. Schedule time every day to review your current and aging A/R. (If you wait to do this every 30 days, it could create a lot more work for you and delay payment even further.) Even better: Use tools (like your industry-leading EMR and billing software) to help you keep tabs on all of your A/R metrics—past and present— in one convenient, always-accessible place.
Staying on top of your practice’s aging A/R can seem like a never-ending job, but it is essential to maintaining a steady revenue stream—and ultimately, making sure you pay your staff and your bills on time and in full. Do you have any tips for staying on top of aging A/R? Share them with us in the comment section below!