A physician’s refund is connected directly to either productivity or collections – and it can be influenced indirectly by the overall financial sustainability of the practice or the hospital. A physician’s payment depends on the employer getting paid for the patients who are treated. It is not always an easy task for young surgeons to understand the interrelated aspects of how a practice bills and collects for these services.
This is an open letter (or guidelines of a sort) to young surgeons, explaining how the revenue cycle works and the key areas that require physician involvement.
The revenue cycle consists of all the steps required in order for a surgeon to receive payment.
First, you need to understand that there are many parties involved, and it is not just the billing department that matters. Everyone around you has a role to play, including you. You have to collect all the right information prior to a patient’s appointment, otherwise, the front desk staff will not know whether patients are eligible for coverage or how much to collect. You might want to be careful when you tell your patient “Do not worry about the bill”. You only end up making your team’s work harder.
Your front-end staff usually has a busy and demanding job that includes constant interruption and distractions – they are often thrust into the position with little to no training at all. It is not surprising that mistakes happen, but they will only delay payment and lead to denials that might result in non-payment. For most cases, if you invest in employee training and orientation, you will reduce major errors. Front desk staff is required to fix their own error, guided by the billing team, which identifies training needs and reduces error rates with time. With this, a common mistake becomes instead a learning opportunity.
Time of service collections
The collection of co-pays must be done prior to the patient seeing the physician. Patients must be registered prior to an appointment so that the staff is able to enter insurance information into the PMS, check their eligibility and then enter benefit information into the patient’s account.
How to set-up for a surgery
Bringing a patient ready for surgery requires a lot of coordination, and this process can be a bit stressing from start to finish. In order to avoid fragmentations along the process, you need to find a surgery coordinator. He’s the person responsible for scheduling time with the operating room, pre-operative testing and authorizations, obtaining pre-certification from the insurance payer and making the final financial arrangements with the patient.
Modern practices collect a pre-surgical deposit as part of the surgery scheduling process. Given the significant increase in patient payment responsibilities during the last several years, many practices also collect the balance of the patient’s portion or set up an automated payment plan for the balance before the date of surgery.
Account receivable follow-up are the sum of all outstanding accounts. Some of the A/R is the patient’s responsibility that was not collected at the time of service, but most of the A/R is usually insurance responsibility. The best practice is to have dedicated billing team members.
A successful revenue cycle involves everyone in the practice. It goes from the receptionist to the surgeon, and participating in the processes that require surgeon input will help establish streamlined and efficient front-end and back-end processes.
If you pay a little more attention to the revenue cycle, the staff productivity and practice will be optimized as well.