For medical practices, the front office team is your front line, ensuring the flow of patient care. At the same time, medical billing specialists keep the revenue stream alive by posting payments and addressing insurance claims and any issues that arise in seeking reimbursement.
It is these critical tasks and the processes used to accomplish them that can determine whether your clinic is maintaining a healthy revenue flow and an optimal patient list.
Marie Stacks, CEO of Clinic-ology, shares her expertise on front office processes, methodologies and best practices at MGMA’s Medical Practice Excellence: Operations Conference on May 20 in Austin, Texas.
Since medical office professionals are typically responsible for hundreds of patient accounts on any given business day, scheduling, charges and payments are tasks that are repeated over and over again.
Yet, there may be numerous variations for each process based on patient specifications. And, perhaps more than in any other industry, regulations and even the principles that guide healthcare can quickly change to respond to a quickly changing environment.
The COVID-19 pandemic is the perfect example. Medical clinics adapted to safety precautions and government restrictions by shifting to tele-health and virtual services and state and federal emergency legislation was not far behind.
This is not an uncommon occurrence in all fields of health care. So, your clinic should seek processes that can basically remain intact even if the details change.
This is why Clinic-ology provides clinics with an office operations assessment, recommendations for improvements, and staff training.
This is not a static, one-step-and-done process. It often takes multiple steps and departments and depends on what is being reconciled and the technology in place to facilitate it.
Here, Clinic-ology looks at the daily reconciliation for patient scheduling, charges and payments to show how your practice can benefit from an operations assessment based on current industry regulations and best practices.
Effective Patient Scheduling Equals Greater Revenue
Front office staff knows that when a scheduled patient doesn’t walk through the clinic doors at the appointed time, it sends a ripple of administrative follow-ups in its wake. So making sure patients show up for appointments should be part of the front office daily checklist and reconciliation.
But first, an assessment is needed.
When every telephone call to remind patients of upcoming appointments takes up to eight minutes, the “call creep,” where one calls turns into two and then three calls, is not an efficient use of staff time. There are better ways to handle patient reminders and reduce the high rate of no-shows.
This is critical when a missed appointment costs a practice an average of $265 and the no-show rate can reach as high as 36 percent for medical practices.
Clinic-ology will help you calculate the no-show rate — for some practices this can reach as high as 36% — and then can show you where to tweak or implement new processes to improve that rate through:
Clear and compassionate communication with patients.
Multiple appointment reminders.
Automation.
Having a clear policy in place.
Developing and maintaining strong patient relationships.
Allowing pre-paid appointments.
Rewarding patients for keeping appointments.
Implementing a schedule cycle that avoids far-in-advance appointments.
Reconciling Daily Patient Self- and Co-Payments
While the exact amount of self-pay bills and insurance deductible and copay amounts depends on the size of your practice, a daily reconciling of payments is essential for a healthy revenue cycle for practices of all sizes.
When reconciliation issues arise, they usually result in unposted payments that challenges a clear picture of cash flow and revenue for your practice. This places financial reporting and projections and an accurate understanding of its financial health at risk. So understanding best practices in the processes and workflows of payment reconciliation will lead to a more efficient system —and likely a faster revenue cycle.
In assessing your clinic’s daily payment reconciliation, Clinic-ology recommends ways to streamline the processes for payment posting to avoid duplications, flag errors before they create issues down the payment line, and clearly communicate to patients their financial responsibilities. Best practices dictate that:
Technology can do a lot but not everything.
Selecting the right software for your clinic is crucial.
Patient payment records are consistently maintained and easy to understand.
Clear practices are developed for managing accounts.
A dedicated account manager performs a weekly accounts review.
Allows appropriate time in the payment cycle.
Practices are ready and willing to adjust processes.
Charge Claims and the Daily Reconciliation
For most patients, the first billing step is through a third-party insurer. However, as most billing professionals already know, claim collections can be quite complex. Patients may have more than one health plan. And claims are usually processed at different times of treatment. At the same time, different insurers often have different claims processes in place.
An accurate, picture of the status of charge claims combined with methodology of reconciling them daily can lead to a faster revenue cycle and greater efficiency for office staff through:
Assessing your electronic fund transmittal (EFT) and electronic remittance advice (ERA) process and tools.
Creation of daily reconciliation steps and checklist.
Development of clear practices for managing accounts, including flagged transactions, denied claims and so on.
Training of team members in all processes and tools.
Additionally, while patients are increasingly more responsible for navigating their particular “payer mix” of insurers, deductibles and copays, they often turn to your office staff for assistance.
So, in the complex and changing world of medical billing, Clinic-ology works with healthcare clinics to implement technology and best practices into the payment reconciliation process and then train billing teams in these practices for better revenue cycle management and a faster cash flow for your practice.
Clinic-ology uses current best practice standards in healthcare operations to bring medical practices to the highest level of front- and back-office efficiency. This leaves physicians and the hands-on medical staff with more time to focus on patient care.
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