1. Insurance verification- Most PM Software can double check insurance information right from the patient demographic page, or you can look it up either online or by calling.
2. Referrals and pre-authorization- It is critical to know what insurance plans and what tests/procedures require pre-authorizations and referrals. Most Tricare, Medicaid plans, and even some BC plans require this even on the first visit. Best practice is to inquire on this for every patient, every time prior to visit.
3. Demographic information- Patient demographics is one of the biggest help or hinderance in getting paid. To avoid demographic problems, verify demographics at EACH visit and get Social Security Numbers whenever possible. Checking demographics at each visit will ensure that the correct address, phone number and insurance is always on file.
4. Collection of patient responsibility- Make sure staff is trained to collect co-pays, co-insurance amounts, deductibles and past due balances at every visit. Collecting these amounts on the date of service will allow the billing process to run smoothly, lower AR, and hold the patient accountable for amounts due. It is always easier to collect in person!
5. Documentation of visit- Are you documenting all you did? Don’t leave any money on the table by missing billing for preventative care or counseling (Ex: smoking cessation)
6. Coding- Verify diagnosis and CPT coding is correct. Diagnosis pointers on claims appropriately identify which CPT codes are tied to diagnosis codes!
7. Claim submission: Do it right the FIRST time. Are you set up to submit claims electronically? Send as many claims as possible electronically! Send appropriate documentation with workman’s compensation and auto carrier claims!
8. Identify Denial Trends quickly- Have an open and close relationship with our billers. It is recommended to have monthly meetings to review denials and claim issues.
9. Do regular EOB (explanation of benefit) audits- Be sure you are being paid according to your contract. It is recommended to have a fee schedule sheet compiled with your fees. Medicare and Medicaid rates and commercial rates for easy quick verification.
10. Collections of past due patient money- Be consistent and effective and have a solid collection plan in place. Focus on the most delinquent accounts first! Timely collection is key!