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  • Writer's pictureRMK HOLDINGS INC.

Bridging the Gap to Secure Revenue

Updated: Sep 29, 2022

Keeping your front and back end processes flowing smoothly and bridging gaps where needed, will result in maximizing revenue flow, something very practice desires! Where do you start? Here are a few focal points to champion a strong billing and collections process.

FRONT: Start Before the Patient Arrives

This means the staff needs to verify insurance and address changes (for every visit!) and then get into the financials like confirming co-pays, any unmet deductibles, or outstanding balances. If the patient has a balance but cannot pay it, bridge the gap and refer them to the back-office staff to discuss payment plans.

FRONT: Send Paperwork Immediately

Whether it’s paper, online, or a self-check in kiosk, ensure the patient knows how to submit paperwork prior to the appointment. This not only saves time but provides an impetus to the patient to make sure all the details are correct. In addition, remind the patient to bring completed paperwork if completed manually, insurance card, co-pay and any patient pay arrangement details. Let patients know the minimum amount that will be collected for the visit.

FRONT: Update Insurance and Mailing Information

Insurance changes constantly and patients sometimes forget that, especially at open enrollment time. Look at the insurance cards at each visit.

FRONT: Double Check

Before the patient exits the office, make sure all the billing and collection details are worked out. Make it easy for patients to pay: cash, checks, mobile, e-wallets, credit cards, and payment arrangements.

BACK: Pay Plan Training

Thoroughly train employees on ways to process all payment types and set up payment plans that are time efficient to the patient and to your practice. It is also good to train both front and back on how to diffuse potential off-putting patient emotions that emerge during financial discussions.

BACK: Daily Reconciliation

Ensure the back-office staff reconciles forms and bills claims each day. Seek clarification from the provider on any treatment issues and verify that clean claims are submitted.

BACK: Denials

Learn or develop denial processes for the back-office staff. This means analyzing the reasons for claim denials. Check for trends. Resubmit promptly.

BACK: Accounts Receivable

Each day, look at an insurance aging report and assess anything more than 45 days old. If claims are not paid within 21 to 30 days, investigate the reasons why.

BACK: Patient Flow

Analyze patient flow and remove any bottlenecks. For example, find out how long it takes the patient to complete the check in process and get to a waiting room. Review the time it takes to schedule the next visit, call prescriptions ins, and provide any handouts after the patient is finished with the doctor or the treatment. By breaking down each process, efficiency gains can be identified and implemented.

BACK: Patient Balances

If this is not outsourced, dedicate a person to follow up on balances and request payments on a regular basis. Ensure missed payment plans are worked without fail.

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