Who Does What?

With reimbursements getting tighter by the day, changing forms and new claims requirements, this is a good time to review your accounts receivable process to make sure it is operating at its best. Plan any improvements you might need so that your process will function as efficiently and effectively as possible.

• Verification of coverage

  Benefits must be verified prior to delivery of equipment of supplies. Determine the beneficiary's deductible amount remaining. Determine the patient's co-pay amount. Find out what DME max benefits are. Have you verified there is no other insurance?

• Collect money up front

  If a deductible amount is due, collect it at the time of delivery. If there is a co-pay amount, collect that money at the time of delivery. If the item is not covered, collect money or set up a payment plan at the time of delivery. When in doubt, collect 20 percent up front and put it toward the deductible.

• Policies and procedures

  Policies for working denials should be written in a policies and procedures manual, and all employees should understand them, agree with them and be trained properly on them.

• Who, what, when and where

  Who is going to execute the agreed-upon strategies? What specific strategies are going to be employed? When will specific collections efforts be aimed at specific payers, and how will you review the effectiveness of those efforts? Where should collections efforts be concentrated to get the maximum return on your efforts?

• Consistency

  Collections efforts must be consistent through the company. Employees must be trained and know their performance will be monitored, reviewed and rewarded on a regular basis.

• Persistence

  Keep a callback log to monitor progress of claims. Get to know the personnel at the insurance company, and build a good relationship with them. Document all conversations as to date, time, patient and content.

• Be flexible

  Adjust your agreed-upon strategies as conditions and experience dictate. Don't abandon your game plan because of resistance from employees or payers.

• Prioritize aged AR

  Figure out the minimum dollar value you will go after, and make a company decision as to what AR amounts you will go after first to get the most money into the company. Analyze your aged AR. Your software can help. Break accounts down by primary and secondary payers, then sort from the highest to lowest amounts owed.