 |
Collection Process at the Billing Agent
Efficient invoice generation is only a portion of the process at the billing agent that effects revenue.
A multitude of issues related to the collection process can have a profound influence on full collection
of due amounts. These issues include:
- Depository function vs. lockbox
- Collection agency relationship to the billing agent
- Electronic remittance
- Line item posting of payments to the appropriate CPT code
- Write-off policies
- Rules defining changes of financial classification and dunning after partial payment
- Number of personnel devoted to unpaid claims
Frequently Asked Questions
What is the most accurate method of calculating collection rates?
Although every billing agent is not capable of tracking payments, disallowances, and write-offs back to
the original charge, this is the most accurate method of calculating collection rates. For example, if
reviewing a time period that spans the previous 15 months, calculate the percentage of payments vs. the
original charge, allowing for some future collections for the AR still in an active status. Then, factor
variables such as change in volume, new physician fee schedules, and/or new payer schedules to predict
future revenue streams.
What formulas should the EP follow to determine adequacy of collections?
The most important figure is the net revenue per patient visit. This calculation avoids differences in
collection percentages that can be artificially altered by different fee structures. If possible, this
calculation should be derived from reports that track payments back to the original charge. Other
important parameters to follow are Days in AR, and % of AR greater than 120 Days. It is critical that
the EP understand the flow and structure of all billing reports as the parameters may appear "acceptable"
even though problems such as premature write-offs of AR to the collection agency have occurred.
How does the EP know if accounts are being worked properly?
The only way to properly assess this is to examine each step of the billing process. Find out how many
claims and statements are routinely submitted. Inquire about what happens when payment is not received.
Track the kind of follow-up work that is done on unpaid accounts. Confirm that the billing agent is
assigning adequate resources to the "back end." EP billing is an intensely detailed, invoice-by-invoice,
process that must be evaluated in the many areas where errors often occur.
BSA Healthcare Services
EMERGENCY MEDICINE & PHYSICIAN SPECIALTY SERVICES
|
| | | | | |
