Issue link: https://viewer.e-digitaledition.com/i/71333
+++++++++++++++++++++++++++++++++ +++ +++ R Increase Your Revenue With Front-End Efficiency By Challette Caine EVENUE CYCLE MANAGEMENT success relies partly on the information collected before the patient even steps into your practice. Incorporating these simple steps in your daily workflow can help your front-end operation increase your practice's bottom line. Accuracy of demographics collected and entered at the time of patient encounter is a critical step in getting your claims paid. Your staff should ask for the patient's insurance card and verify all pertinent information every time the patient comes in for a visit. Insurance coverage can change during the course of the year and so can patient addresses, phone numbers, marital status and employment. Insurance verification should be com- pleted the day before a patient's scheduled visit. Electronic eligibility verification in your practice management (PM) system can be scheduled to run in advance so non-eligible and non-covered patients can be prompted for an update of insurance coverage upon arrival. Running a patient outstanding balance report in advance will also help increase collections. Appointment reminder calls to your patients should also be used to inform them of the amount of their copay, coinsurance, deductible and outstanding balance. Scheduling these reminders in a patient portal built in your PM system can also be used to great effect. Of course, copays should be collected at the time of patient service and prior to the physician seeing the patient. Remember that copays can be different for a primary care physician and a specialist. Office staff should be aware of the patient's insurance requirements for an authorization before the visit and how many visits the insurance approved before scheduling an appointment for the patient. Patients referred to a specialist most likely will require an authorization. A good PM/ EMR system will be able to record the approved number of encounters and warn you before the patient's last approved visit. Most insurance companies will not authorize for services previously rendered resulting in your writing off that service without payment. It's essential that your practice under- stand the importance of an Advance Beneficiary Notice (ABN). An ABN is a waiver providers are required to present to patients when services or items are offered that the provider knows — or has reason to believe — that Medicare will determine to be medically unnecessary and will not pay. ABNs provide an important safety net for your bottom line. If your office does not obtain a signed ABN before the patient receives the service or item and Medicare does not pay for the service or item, then you cannot bill the patient. However, if your office obtained a signed ABN prior to the service and Medicare does not pay, then you can bill your patient. Your office is responsible for obtaining a signed ABN – completely filled out and discussed with the patient. If you obtain an ABN signature, your claim should have the GA modifier and you should include a note in your EMR that a waiver was signed for that specific service. An ABN form can be obtained online at www.cms.gov/BNI. Use an ABN for your com- merc i a l and self-pay patients, too. Signing an ABN will ensure the patient's liability for the services rendered and eliminate write offs. Finally, if your practice is still using charge tickets, your staff should reconcile the scheduled appointment for the day with the number of charge sheets collected. The charge tickets should be reviewed for accuracy regarding procedures, diagnosis, and coding modifiers. Charges should be entered in your PM system the same day or the day after the visit. Charge lag time will definitely affect your collection. An established, accredited and integrated PM/EMR system is the best way to track your charges. This eliminates misplaced or lost charges, tracks your "no shows" and cancelled appointments, and submits clean claims to insurance companies resulting in fewer rejections and faster payments. Now would be a good time for your practice to audit your front-end staff performance, improve practice workflows and maximize your cash flow. Challette Caine is the director of Revenue Cycle Management for Independent Physician Solutions (IPS), a subsidiary of the Sisters of Charity Health System, located in Brooklyn, Ohio. ■ +++++++++++++++++++++++++++++++++ SPECIAL SECTION: BUSINESS + + JULY-AUGUST 2012 ■ MDNEWS.COM ■ MD NEWS Cleveland-Akron-Canton | 35