Does your practice provide post-op or follow-up services to your patients? I am sure you do. Do you consistently post-op (or follow-up) your accounts receivables (A/R)? Sometimes? Just as you need to follow-up a patient’s care to insure the patient is responding to treatment, you need to follow-up your accounts receivable to be sure carriers are responding to your claims.
Can you be sure that your claims always arrive at the insurance company and that those claims are always paid in a timely fashion? Of course not. Even with the most reliable claim’s transmission process it is not uncommon for claims to be lost in transmission, lost by the carrier, or slow paid by the carrier.
Medical practices that are losing money sometimes cannot seem to pinpoint the reason why. It could be inexperienced billers or too much turnover in the billing department or just as often, improper or non-existent follow-up of the claims sitting in the accounts receivable. On average your A/R should total approximately an amount equal to one month’s charges; it’s not uncommon for practices to carry as much as two to three months worth of charges. With proper follow-up these dormant claims could add thousands of dollars each month to your income. These same practices often carry a large percentage of their total A/R for more than 90 days. While there are different statistics concerning A/R aging for different specialties, a healthier over-90-day percentage is less than 20 percent. Our goal for our clients is to keep that number less than 10 percent.
Too many times practices discount the importance of claims follow-up in exchange for other areas of work within the practice. These other areas are important, of course, there are good reasons why claims follow-up should be very high on your priority list. Following are a few examples of common procedures and their Medicare allowable amounts.
99213 – Level 3 Office Visit $69.85
11400 – Excision of Benign Lesion $119.39
45378 – Colonoscopy $390.07
49505 – Hernia Repair $515.35
When billing services are hired to handle a practice’s billing, many times they also asked to follow-up their existing A/R. Claim follow-up can be done by calling carriers directly, using carriers phone IVR systems or through services such as Navinet and Emdeon. It is not uncommon to find that 40 percent of unpaid claims never even made it to the carrier. Simply resubmitting those claims can quickly produce a great deal of income for the practice. Many claims sit dormant in the carrier’s system waiting for minor updates; once corrected, the claim often will pay. When your office reviews the above allowable amounts and equates that to a worker’s hourly expense, it is easy to see that expending resources for follow-up will bring you far more in return that you are spending.
A good treatment plan to insure a healthy bottom line should always include consistent post-op care of your accounts receivable.
Written by Brad Runyeon, President of Accumed Billing Services, Inc.