DESCRIPTION:
The challenge of the home care industry is to continue to provide quality service and building trusting relationships through excellent customer service while building a basis to collect for the services provided. Attendees will be provided with a review of the ten important tactics of accounts receivable management.
OBJECTIVES: At the end of this session, the attendee will:
Be able to identifying trends within their organization. Know who should be included on their A/R team. Have tips for educating referral sources about DMERC medical policies. Know when to turn to an outside source for assistance. Understand why the CSR is where the buck starts.
BIOGRAPHY OF SPEAKER: A. Maureen Hanna
Maureen Hanna is an industry reimbursement consultant with Healthcare Reimbursement Consultants (HRC), Inc. located in Fountain Hills, Arizona. Maureen is an experienced trainer in the home medical equipment (HME) services industry on reimbursement, claims processing, medical documentation and compliance issues. She has worked in the HME industry for 16 years including 4 years as a director of a national provider company. Maureen has authored articles in several industry trade journals and is a frequent speaker at national, regional and state medical equipment conferences.
Since 1992, over 300 health care organizations have depended on HRC for the information necessary to improve, monitor and evaluate quality in customer service and accounts receivable departments. Our clients benefit through highly competitive professional rates that enable them to address a wider range of necessary projects. We are sure that you will find our services valuable and of great assistance to your company. We look forward to meeting with you and further discussing our services.
Webpage: http://www.primenet.com/~mhanna
TACTIC # 1 - IDENTIFY TRENDS
Purpose:
To give the organization a better picture of the status of their A/R and the organization. Will assist in determining if there is an adequate number of staffing. Can serve as a tool to meet with staff to show progress and determine priorities.
Examples:
A/R aging by payer
Total past due dollars
Days sales outstanding (DSO)
Revenue
Net Revenue Unbilled revenue Unbilled revenue in days Average daily revenue
Net accounts receivable
Past due accounts
Past due as percentage of net A/R
Bad debt
Current months Bad debt as % of revenue
Cash receipts
Current month’s cash receipts Cash receipts as percentage of revenue
Unbilled revenue
Amount Reason
Staff productivity
# HCFA-1500s # Denials # Development letters/request for additional information $ Unidentified cash
# Invoices past 120 days
# Rx’s greater than 4 weeks
$ Cash to be applied
TACTIC # 2 - QUALIFY THE PATIENT
Purpose:
The reimbursement structure that can help a supplier get paid is the same for all payers: collect complete information at point of sale, verify benefits, seek prior authorizations, generate a clean claim and collect on the claim.
Information, communication and documentation are the keys to private insurance reimbursement.
Examples:
An insurance verification form should always be completed prior to delivery.
Don’t just verify that they have insurance get all the details. Document it.
Request that a written statement be supplied showing denial of coverage, for use in your records as well as for billing secondary insurance. Get the full name of the person stating the denial of payment or coverage of services.
TACTIC # 3 - UNDERSTANDING THE PAYERS
Purpose:
Puts the supplier on a more level playing field if they know the rules of the game before it gets started.
Examples:
Meet with the payer.
Don’t wait until there is a problem.
Understand their payment policies and procedures.
Analyze your payer mix.
Don’t forget other resources that can assist you.
Understand the role of a Case Manager.
TACTIC # 4 - MANAGED YOUR UNBILLED
Purpose:
These are services you have provided but can never collect unless you get the claims/bills out the door.
Examples:
CMNs
Prior approvals
Quotes
What is your days and amount of unbilled?
Tracking
TACTIC # 5 - MANAGE YOUR CMNs
Purpose: Without documented medical necessity, Medicare (and many other payers) will not pay.
Examples:
Identify who is your key person for tracking CMNs.
Use of cover letters
Determine a mailing schedule. Include it in your policies and procedures.
Hand carry
Fax
Phone calls
Know the regulations.
TACTIC # 6 - DEVELOP EFFECTIVE SYSTEMS AND CONTROLS
Purpose:
Without controls in your organization you will soon be out of control!
Examples:
Computer
Holds EMC Software Productivity reports by payer Upgrades Productivity reports for staffing
Manual
1-31 day files January - December file
Denial ratios
Productivity reports for staffing
TACTIC # 7 - DEVELOP CONSISTENT BILLING AND COLLECTION PROCEDURES
Purpose:
Billing and collection procedures set the same standards for all. If clearly defined, will lay the groundwork for what is expected of you. Revisions WILL be required.
Examples:
What are your policies and procedures?
Make a list of ones still required. Prioritize this list.
Is your customer/referral source aware of the policies and procedures?
Standardize collection letters
Identify collection agencies
Payment floors
Consider bi-monthly statements
Early payment discounts
TACTIC # 8 - ORGANIZE AN A/R TEAM
Purpose:
No one man is an island. We must rely on a variety of sources to make timely delivery of products and receive adequate payment for the services we provide.
Examples:
Include all staff such as sales/marketing, CSR, A/R, Delivery Technicians, Management, Account Payable and Medical Director.
Define roles and responsibilities.
Hold weekly staff meetings with all staff included.
TACTIC # 9 - AGRESSIVELY PURSUE COLLECTION ACTIVITY
Purpose:
Every dollar your organization may end up writing off could be your profit to the bottom line.
Examples:
Medical bills are the least important bills that a consumer will pay each month.
Look at alternate funding sources.
Consider COD.
Don’t forget copayments and deductibles.
Days sales outstanding (DSO).
What are you willing to write off?
Know the Fair Debt Collection Practices Act.
TACTIC #10 - UTILIZE KEY REPORTS
Purpose:
You can’t be everywhere at once. With reports you can at least get a handle on things.
Examples:
A/R aging
Bad debt by reason
Indigent care
Denial tracking
Days sales outstanding (DSO)
2001 Copyright Healthcare Reimbursement Consultants, Inc. (480) 837-3229
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