In addition to these insightful conversations, I had the honor of leading an educational session about preparing for the pending 5010 and ICD-10 transitions. During the hour, I provided tips about how every practice can prepare for the implementation of both 5010 and ICD-10, especially focusing on how practices can ensure that they have mitigated the possibility of revenue cycle disruptions during the transitions. During the session, there were many great questions and I was happy to see people starting to think about the transition to ICD-10. In addition, Healthcare Finance News wrote a quick synopsis of the session, which you can read here.

I look forward to hearing how people take these recommendations and apply them to their own practice. As your organization works towards both implementation deadlines, let everyone know how it is going by adding a comment in the boxes below.

That’s one reason why, in January 2008, we transitioned from our former traditional clearinghouse to a web-based clearinghouse solution. We’ve found some distinct advantages.

For example, a web-based system can help you identify and fix errors in a claim before submitting it for payment. This ensures the cleanest claim and reduces back-end rejections. With our earlier clearinghouse, we typically didn’t know about claim errors until we actually received the rejected claim. At that point, we needed to resubmit a corrected claim. The whole process could take several days to complete.

While traditional clearinghouse systems may initially cost less, a web-based system allows you to make changes quickly, get clean claims to the payer faster, and get paid faster—thus reducing days in accounts receivable. You can send off a batch of claims and know within 10 or 15 minutes whether they were accepted. Ultimately, by speeding up the whole revenue cycle, this helps the entire bottom line.

We also found the automatic eligibility tool to be a real lifesaver. It enables us to batch our eligibility requests to our clearinghouse. Then we receive a rejection report, highlighting only those patients found not eligible. Thanks to this report, our eligibility staff doesn’t have to verify all 700 patients the practice may see on a particular day. Instead, they focus their efforts on those patients who show up on the rejection report. This has allowed us to increase the number of patients we see—without negatively impacting our ability to verify eligibility.

Another big advantage of a web-based clearinghouse is its reporting capability. Our former clearinghouse had little to no reporting capabilities so I did not have a clear picture of my overall financial performance. Now, I create reports in real time to analyze revenue cycle performance and identify opportunities for improvement. I can also identify the types of processes that often yield errors, or pinpoint specific services and locations with higher-than-average rejection rates.

Additionally, our clearinghouse has some other features we’ve also found beneficial. Rejection aging alerts help us keep on top of unpaid claims rejected 30, 60, or 90+ days ago. You can look at snapshots by type of error, provider, location, and so on. The denial management feature details the entire claims process, showing me in real time the number of claims submitted, rejected, and in progress. For instance, after sending a batch of claims, I can quickly generate a tracking report that shows which claims went through, which need correcting, and which are in process for payment.

Investing in a comprehensive web-based clearinghouse solution is one reason we’ve been able to grow our business steadily—without adding a single new FTE in the business office. It helps us easily identify our potential and capacity for growth, while streamlining current processes. It supports new business without increasing the cost of doing it.

About the Author:

Regina Hayes is the Business Office Manager for Orthopaedic Specialists of the Carolinas, a three-location practice based in Winston-Salem, NC. She oversees all of the practice’s revenue management functions.

I take pride in the fact that even with such a large claim volume—and four different locations—we average about 30 days in A/R. We’ve managed to accomplish this through a few distinct efforts.

First, we have become more proactive about collecting patient-pay balances prior to surgeries and other high-dollar services. With the difficult economic times, many patients have either lost their insurance or opted to increase their deductibles—which obviously has a direct impact on A/R.

Eligibility solutions can help not only with the business side of operations, but also with patient care. Rather than simply billing patients for an amount they may or may not be prepared to pay, I want to give them as much autonomy as I can in their healthcare decisions. So, for any high-dollar service we offer, we use an eligibility solution to check benefits and tell patients upfront how much a procedure will cost out of pocket.

It’s a win-win situation: Patients benefit from the ability to make fully informed decisions about whether to proceed with recommended care; and we benefit from the ability to request payment prior to service. We can sit down with patients to construct payment plans that meet their needs—and increase our overall rate of payment.

On the insurance side, we also make sure we’re sending clean claims out the door quickly. I’m certainly not the first business manager to recognize the importance of solid editing tools. But we definitely speed turnaround through the ability to see claims errors online, and then fix them online without having to resubmit from our practice management system.

Electronic payment posting is yet another factor in our overall A/R success. It is a function perhaps not typically associated directly with A/R, yet a “receivable” is still just that until the money is deposited. Electronic posting has been so beneficial for our payment posters, now that they don’t have to touch every single patient claim. Their efficiency is such that we need fewer than two full-time equivalents (FTEs) to post our entire volume.

Holding down A/R days results from efforts made throughout the revenue cycle. It starts with arming both the practice and patients with information necessary to work together toward payment and care. It continues with tools that increase the efficiency of claims submission. And, finally, it ends with solutions that ensure we are accurately depositing every dollar our providers work so hard to earn.

What solutions do you have for keeping your practice’s A/R days in check? Share your experiences below.