1. People and accountability. “During the hiring process, you must clearly communicate the duties of the position for which you are hiring,” says the report. “The job descriptions for the entire billing department must include all of the multiple steps required to successfully complete the medical billing process. In addition, the changing billing environment requires you to keep staff current through continuous learning and processes that measure and evaluate staff performance.”
An important benchmark for this area: 100 percent of the gold-standard practices had employee turnover rates of less than 3 percent, “which assisted in maintaining a continuity of processes.”
2. Internal monitoring of systems. “High performing practices consistently analyze the information and reporting from their practice management systems, as well as the information provided through their clearinghouses,” says the report. They also “continuously compare their numbers with their own historical numbers as well as those of other similar practices in the industry.”
Ninety-percent of the top practices monitor their A/R and other processed related to the revenue cycle.
3. Processes. Here, the top performers have four key formal policies and procedures:
– Charges are posted and claims transmitted within 24 hours of service.
– Payments posted within 48 hours of receipt by practice.
– Any type of denial is followed up within 48 hours of receipt by practice.
– Patients receive statements within seven to 10 days of a balance becoming their responsibility.
4. Coding. “Top performers understand that coding is one of the top compliance concerns for most practices and take the steps necessary to ensure coding is accurate,” says the report. Those steps include the following:
– 70 percent of physicians code the services they render; 30 percent entrust this function to staff.
– Of those who do their own coding , 91 percent require the coding to be reviewed by the billing/coding office staff before submitting the claims to payors.
– Forty-eight percent had at least one certified coder on staff.
5. Third-party A/R and denial management. “Tracking denials from several points in a practice helps correct the root issues,” says the report. “Successful practices focus on tracking denials received from the clearinghouse, from payment posting and insurance companies.”
6. Collections. “Nationally, patient balanced are growing due to higher deductibles, co-pays and co-insurance amounts,” says the report. “This trend has created an environment where practices must take a more proactive role in handling their patient balances.”
As a result, 70 percent of top performers now discuss existing balances with patients before visits and 74 percent review co-pays before visits. All the practices also accept credit cards, offer self-pay discounts and set up payment plans in order to stay on top of patient balances.
7. Reporting and measuring. The following reports should be run on a regular basis, according to the report:
– accounts receivable aging total;
– accounts receivable aging patient balances;
– accounts receivable aging insurance by payor, summary;
– credit report line item and account total;
– unallocated/undistributed payments, summary;
– adjustment report by adjustment type and operator; and
– financial summaries with payments, charges and adjustments.
8. Technology. The top-performing practices make full use of practice management systems to “decrease errors and denials, create efficiencies by reducing the manual processes, and reduce the amount of time spent on:
a. insurance eligibility/benefits;
b. daily claim submission;
c. electronic patient statements weekly cycle billing;
d. electronic remittances received from payors;
e. electronic fund transfers (EFT) from payors; and
f. daily review/correction of electronic data interchange (EDI) denial reports.”
9. Managed care contracting and fee schedule reviews. Sixty percent of the practices use Medicare RVU factors or a percentage of the Medicare allowed in determining their fees. Doing so lets these practices “report on incidents where the payor had paid less than their fee schedule and request additional payment.”
Forty-three percent of the top performers update their fee schedules yearly; 17 percent update every two years; and 34 percent update as needed. “Managing each payor contract for provisions such as silent PPOs or extensive recoupment of overpayments is essential to having effective agreements,” says the report. “Further, better-performing practices ensure that the maximum reimbursement possible can be attained with each payor contract through active dialogue with their representatives and market review of the current allowables.”
Download Physician Revenue Cycle Gold Standard Study (PDF). Learn more about LarsonAllen; learn more about Gateway EDI.
