Has being a physician become more about paperwork and insurance reimbursement than patient care? Make sure your billing partner or billing department is willing and has the resources to fight for every cent you have earned.

Many offices leave up to 40% of their potential reimbursement on the table because they lack proper processes, are understaffed, staff is not adequately trained or has inappropriate incentives, or the office has not invested in appropriate technologies. Here are some common mistakes that keep physicians from getting every cent they have earned.

• Mistakes in patient registration—Revenue is lost from not collecting or verifying insurance eligibility as well as forgetting to collect copays. This also is where and when a practice should address outstanding patient balances.

• Missed encounters review—Billing staff never submits bills to insurance companies for about 4% of the patients you see.

• Inappropriate fee schedules—Depending on the specialty, the fee schedule should be set at an appropriate multiple of the Medicare fee schedule and reviewed and updated twice a year. Contracts should be reviewed annually.

• Down coding—Not billing and documenting appropriately is common. A coding audit can help you understand if you are being too conservative or are documenting incorrectly.

• Passive claim follow-up—We believe in proactive claim follow-up every 14–21 days until the claim is resolved. This allows you to reduce your cash conversion cycle and catches the 2%–3% of claims that insurance payers typically “lose.”

• Poor secondary filing processes—Many offices or billing companies skip this often time-consuming process because the ROI on the cost to staff this function does not always pay off; however, you could be leaving 3% of your reimbursement on the table.

• Line item EOB posting—Each line of the EOB must be separately reviewed, posted, and followed up, if necessary.

• Poor or nonexistent reporting—The billing manager needs to review key performance metrics each day and provide monthly comprehensive revenue analysis reports to the physician and office managers. If you cannot measure it, you cannot manage it. Understanding these details and how they affect your business is the basis for effective practice financial management.

• Not tracking denial and rejection trends—Each area of the office needs to understand how its mistakes can affect reimbursement so the same mistakes are not made twice.

• Outdated technology—Are your PCs updated? Do you use a web-based practice management system? Have you invested in a coding/claim scrubber? Do you submit claims electronically? Do you use ERA for posting? Have you reviewed EMR options?

• Making a decision based on price—Understand the benchmarks and ranges for what billing companies charge in your area and for your specialty; however, not all operations are equal. Often, a low-price option can undercut the competition because it is neglecting many of the labor-­intensive actions required to chase down every penny you have earned. Also, factor in costs for items like secondaries and patient statements. Do a point-by-point comparison among options to ensure that the companies are providing the level of service detailed above. Saving a little money on the billing company’s rate is not a win if it is not collecting all the money it should.

You should also benchmark your results and track these trends. Some common goals are a having 97% collection rate, receiving 50% net collections of gross charges, keeping less than 5% of your A/R over 120 days, and maintaining a 100% collection rate at the front desk. For an office with a strong billing team, the first 85% of your payment should come in within 21 days. The next 12%–15% is more difficult to collect and more expensive for an office or a billing company to properly staff the functions that are required to retrieve your money. Make sure you have a partner that is willing to fight for every cent you have earned.

For more information about this article, contact Hunter Howard, president of MediGain, at hunter@medigain.com, or visit www.medigain.com.