When you consider the many complex aspects of running a private practice, your bottom line might be the biggest source of anxiety. And that’s for good reason; it’s your lifeblood. In an effort to improve your metrics, you’ve likely examined your workflow, documentation practices, and staffing requirements for any possible improvements. That’s a great start, and I encourage you to stay on top of self-evaluation in all of these ways. But have you ever stopped to consider the fairly simple factor that’s impacting your financial success—either positively or negatively—every single day? I’m talking about anal retentiveness (not sure if there’s an ICD-10 code for that) and an overarching dedication to accuracy, especially when it comes to billing. (That’s why we’re devoting this month’s blog articles and webinar to optimizing your billing workflow.) After all, if your claims are inaccurate, they don’t stand a chance of acceptance. The speed and efficiency with which payers process your claims—both of which depend entirely on the accuracy of those claims—fuel your practice’s cash flow and keep your business humming along smoothly. That means you need to send out clean claims—the first time, every time.
The process of crafting a clean claim starts well before the patient walks through your clinic’s doors. Your front office staff is responsible for gathering and entering the information crucial to submitting a clean claim, and that means some level of human error is inevitable. But even the smallest demographic information mistakes—entering the wrong date of birth, misspelling the patient’s name, or recording the wrong address, just to name a few—can lead to claim denials. According to this Healthcare Finance article, “When these claims are denied, it almost always doubles the time it takes to turn around a claim, affecting the practice as well as the patient.” Doubled turnaround time means double the delay until you get paid. All of that time adds up, and just one payment setback can make a big difference.
What’s worse: demographic information errors are very common. This BMGI case study reveals that upon evaluating 386 patient charts, “78.2 percent of the denials were due to the presence of incorrect demographic information, with almost half due to inaccurate insurance information.” That represents a huge improvement opportunity for practices willing to put in a little extra effort during the patient intake process.
When providing their insurance information, most of your patients have good intentions. But even those with the best of intentions can’t prevent the lost-in-translation flubs that can cost your practice dearly. It might seem like a huge timesaver for your staff to document insurance details based solely on a patient’s verbal confirmation of his or her information, but that’s not enough to produce a clean claim from the get-go. That’s why it’s so important to dig deeper. When a patient comes into your clinic, your front office staff needs to get a copy of the patient’s insurance card and ID. That way, you have something concrete on hand for reference. Additionally, it’s imperative that your staff verify all spelling, demographic, and insurance information—and they must do this at the beginning of every new episode of care and at the end of the insurance provider’s enrollment year. This means that your front office staff must know the calendar cycles for all contracted insurances. (For example, the benefits period at WebPT resets every May—not on January 1 like a lot of plans.)
Another must-do is insurance verification. Some patients no longer have coverage, but think they still do. In those cases, the insurances definitely are not going to foot the bill. Typically, you can resolve this issue by calling the patient’s insurance company to verify coverage, copays, coinsurances, and deductibles. An even easier way to verify patient insurance is to check coverage online. Many insurance companies and clearinghouses have online portals where you can easily verify coverage with a few clicks. Keep in mind that you must be credentialed with an insurance company in order to access its verification system.
To make sure claims get paid, you should create a set list of protocols—and hold your staff accountable for adhering to them. That way, claims will not only get paid, but they’ll process quickly, too. Here are some general steps you can take to clean up your claims, as adapted from this Physicians Practice article:
Your front office staff will have first contact with the patient. It’s imperative they collect the following patient information:
- Name (with confirmed spelling)
- Date of birth
- Phone number and address
- Social Security Number (if applicable for billing insurance)
- Insurance identification information, including
- phone number from back of card,
- the subscriber (which sometimes is not the person you’re talking to), and
- the subscriber's date of birth.
Your back office acts as a second set of eyes during the intake process. It’s crucial for this person (or team) to double-check everything the front office staff initially entered to ensure that:
- both the patient's demographic information and insurance information are correct;
- all of that information matches what the insurance verification states, including deductibles, copayment or coinsurance requirements, out-of-pocket amounts, claims addresses, and details regarding the benefits provider; and
- the insurance company’s billing address is correct. One insurance company can have multiple addresses or payer IDs based on contract or location. Making sure your claim gets to the right department at the insurance provider ensures a much more timely payment.
I’ve said it before, and I’ll say it again: It’s important your back office staff knows the ins and outs of insurance companies and policies. If your back office finds that their information doesn’t match up with what the front office entered, they must confirm the discrepancy and get clarification from the front office staff. If you fail to confirm this information—and thus, fail to collect copays and coinsurances—you’ll likely end up surprising a patient with an unexpected bill. Then, in addition to dealing with an unhappy client, you also will have to go through the rigmarole of resolving a denied claim.
Getting paid isn’t solely dependant upon services performed. You’re also relying on your staff’s attention to detail. If you’re finding that human error is often to blame for your practice’s financial woes, then you can boost that bottom line in no time with some extra attention to that one simple word: accuracy.