{"id":1823,"date":"2015-03-31T15:09:02","date_gmt":"2015-03-31T15:09:02","guid":{"rendered":"https:\/\/www.billingparadise.com\/blog\/?p=1823"},"modified":"2026-03-11T04:13:24","modified_gmt":"2026-03-11T09:13:24","slug":"8-strategies-for-getting-paid-at-your-medical-practice","status":"publish","type":"post","link":"https:\/\/www.billingparadise.com\/blog\/8-strategies-for-getting-paid-at-your-medical-practice\/","title":{"rendered":"Get paid at your medicalpractice with these 8 startegies."},"content":{"rendered":"

Effective strategies by billing veterans!<\/strong><\/p>\n

Being a physician, you have had your own experience with payer tantrums. Any doctor will give you plenty of such experience. You know, that complaining about the lack of resources alone won\u2019t help. But if you get a clear idea, of what rules the payer adheres to that cause the maximum hurdles and implement strategies to evade the worst payer trick, can help you collect all that you are due.<\/p>\n

How can you evade the worst payer trick and the patient\u2019s excuses to pay? The effective strategies recommended by our billing veterans are to get paid all that you are due.<\/p>\n

#1 It\u2019s time you create an AR management checklist!<\/strong><\/p>\n

According to the Centres for Medicare and Medicaid Services:<\/p>\n

20% of the claims submitted are denied and 10% of the claims are lost or ignored<\/p>\n

60% of denied, lost, or ignored claims will never be resubmitted<\/p>\n

18% of claims will never be collected<\/p>\n

Medical Group Management Association (MGMA) estimates that payers underpay practices in the U.S. by an average of 7% \u2013 11%.<\/p>\n

14 tips and tricks that every practice should know!<\/strong><\/p>\n

Your billing staff should know the performance standard and expectations<\/p>\n

Cross-train your staff to teach them more than their specific job<\/p>\n

Explain to your billing staff the elements of a clean claim and develop a training program<\/p>\n

Get an AAPC-certified coder or encourage efficient staff members to learn more about coding<\/p>\n

Focus on payer relationships and contract management. Don’t miss any problems<\/p>\n

Maintain a warm relationship with your payers to well understand their policies<\/p>\n

Check the payer contract if it defines elements of the clean claim, payment and submission needs, the appeal process, termination causes, and methods<\/p>\n

At scheduling time, review patient account balances<\/p>\n

Prior service, verify patient eligibility, co-pays, and deductibles<\/p>\n

Verify patient eligibility at every visit and collect co-pays and deductibles upfront<\/p>\n

Post charges for all office visits on the date of service.<\/p>\n

You can get away with aggressive tactics later if you follow up on outstanding claims early<\/p>\n

Set the priority for claims follow-up based on amount and age<\/p>\n

In reply to patient needs build a structured payment policy<\/p>\n

#2 Use your PMS to analyze underpayments!<\/strong><\/p>\n

How confident is your billing staff that you are paid according to the contract? Your practice leaves significant money on the table by not knowing this. There is an option in some PM systems to directly upload the payer fee schedule and, you can compare the payment amount to the contract amount on a per-transaction basis. Some practices run exception reports to find underpayments. You can take a more modern approach by getting a software program at a reasonable rate, for underpayment analysis. And yes, there are third-party applications available at an inexpensive cost to help you analyze underpayments, and allow you to appeal those.<\/p>\n

#3 Develop the best denial management strategy!<\/strong><\/p>\n

It would be the best way to avoid denial if you could find a way to make sure that you create accurate claims. It seems difficult but it is possible.<\/p>\n

According to AMA, up to 5% of claims are denied and with the implementation of ICD-10, this number is expected to rise by as much as 200%. A better investment in denial management<\/a> is to provide continuous education to coders, to help them identify potential documentation errors and enable them to code with the highest level of accuracy.<\/p>\n

Claim resubmission demands more dedicated time and staff and is more expensive and exhaustive when compared with an investment of ensuring first-time claims are correct.<\/p>\n

Technology is the best tool when it comes to denial diagnosis. The first step to fixing the problem is finding the common link among your denied claims. It is very simple but mostly ignored. But if the problem is bigger, more to do with the system, it’s time you need to fix up the department rather than just cleaning claim denials.<\/p>\n

In addition to understanding the reason for claim denial, acting on the denial as soon as you are informed and turning the denial around is the most essential. To address claims concerns in a timely manner-spending less time strategizing, for better communication and overall response time, the best way will be to build efficient claims processing directly with the carrier.<\/p>\n

How do you identify the potential area of errors? I would suggest you look for ways to make your operation more accurate and efficient. It’s not only the practice administrator to be held responsible. Encourage your staff to come up with issues, innovations, and suggestions. Those who do billing and coding for you, are the ones to help you find out why you are getting claim denials.\u00a0 Don\u2019t miss their insights.<\/p>\n

Some of the common claim denial reasons<\/strong>:<\/span><\/p>\n

Uncovered patients<\/p>\n

Required referral\/pre-authorization missing<\/p>\n

Medical necessity<\/p>\n

Coding errors<\/p>\n

The Health Care Advisory Board asserts that 90% of the above denials are avoidable, and more than half are recoverable.<\/p>\n

What should be your next course of action in case of claim denial?<\/p>\n

Create a case of why should the denial be re-appealed<\/p>\n

Get firm documentation to support it<\/p>\n

Monitor your data and keep checking it frequently<\/p>\n

Find out the doctors\/locations with the highest number of write-offs<\/p>\n

Frequently keep reviewing billing and coding practices.<\/p>\n

#4 It isn\u2019t tough using online payer tools!<\/strong><\/p>\n

Why should you wait on the phone for hours to get the correct reason for denial? It’s a better and easy-to-use tool available on payer websites. Last month Colorado launched a Multi-Payer Data-Sharing Online Tool. The data from all payers that are involved will be linked together in this tool so that providers can log in to check all the claims. Dr. Judy Zerzan, chief medical officer, and deputy director, of the Colorado Department of Health Care Policy and Financing (Colorado Medicaid), say, \u201cRight now, I would get, it use to be paper but now more often its email, notifications from different plans saying \u2018here are the patients you took care of that had diabetes and how they scored on their quality metrics\u2019 and depending on how many different payers I have seen patients of, I would get eight, nine, or 10 different reports\u201d<\/em>.<\/p>\n

#5 Keep an eye on payer contracts and the end dates!<\/strong><\/p>\n

One of the major reasons for underpayment is the complications of the contracts medical practices sign. By not reviewing your contracts well, you are leaving money on the table. There’s a possibility that a physician’s contract contains a “most favored nation clause”. This clause might be there in your contract as follows \u201cProvider shall charge another third party payer as much as or more than the rate charged to Payer for the same services covered in this agreement\u2019s Rate Schedule.\u201d Don’t miss to check the “Evergreen Contracts” which changes itself from one term to the other without any notice.<\/p>\n

#6 Get the patient in your battle<\/a>!<\/strong><\/p>\n

In order to build an effective collection plan, patient education is a must<\/strong>. The patient can be the best ally when you need it. In cases where you don’t get any information on why some claims are being denied, inviting the patient to your battle can fetch you the information you looking for.<\/p>\n

#7 Why you need to explain your financial policy to patients<\/strong><\/p>\n

You have created a financial policy, but if you don\u2019t explain it to your patients it won\u2019t matter. A maximum of 5 minutes spent explaining to the patient, why your policy demands to collect co-pays and deductibles upfront can fetch you thousands of dollars. Create a different payment procedure for patients with high deductibles. Most practices complain that their front office staff feels uncomfortable explaining their financial policy to patients. \u00a0Take out an hour daily for your staff and conduct a roll play until they gain confidence in explaining the policies to patients thoroughly.<\/p>\n

#8 Develop a <\/strong>concrete<\/strong> collection plan!<\/strong><\/p>\n

How far in advance do you remind your patients about their appointments, co-pays, deductibles, and policy term date? The best way to improve collection is that your front office-staff well understands the patient\u2019s insurance coverage and benefits<\/strong>. This can be achieved by doing patient eligibility verification. If you do it right you have accurate information, and it gets easier to collect payments from our patients.<\/p>\n

What if the patient walked out before you could collect the payment? Using the U.S. postal services to send bills and followup involves more costs and can take more than 90 days to work out. Patients are more tech-savvy, so the better way is to allow your patients to access the online payment portal. This would improve your collections by a high margin. Some practices use automated mail and collection procedures. This procedure uses secure email\/messages and even automated calls to ensure patient knows about his balance and has the time to pay it.<\/p>\n","protected":false},"excerpt":{"rendered":"

Effective strategies by billing veterans! Being a physician, you have had your own experience with payer tantrums. Any doctor will give you plenty of such experience. You know, that complaining about the lack of resources alone won\u2019t help. But if you get a clear idea, of what rules the payer adheres to that cause the […]<\/p>\n","protected":false},"author":2,"featured_media":1826,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[743],"tags":[],"class_list":["post-1823","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-practice-management"],"modified_by":"kiruthika","_links":{"self":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/posts\/1823","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/comments?post=1823"}],"version-history":[{"count":4,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/posts\/1823\/revisions"}],"predecessor-version":[{"id":450240,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/posts\/1823\/revisions\/450240"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/media\/1826"}],"wp:attachment":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/media?parent=1823"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/categories?post=1823"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/tags?post=1823"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}