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Speeding Up Payer Reimbursement: What You Can Do On the Front End of the Revenue Cycle

Every practice wants to get paid faster. With the many moving parts involved in the revenue cycle, this may seem like a lofty goal. However, there are some specific things practices can do on the front end to speed up payer reimbursement. For example, practices can proactively verify eligibility, support timely charge entry, and use technology to streamline claims submission and payment.

Here are a few suggestions for effectively using these strategies to speed up payer reimbursement:

  • Proactively verifying eligibility: Ideally, you should verify patient eligibility two to three days prior to the scheduled appointment. If your practice management system has the ability to create batch files, this is always recommended over real time eligibility verification. This will allow your practice to work by exception, only having to follow up on ineligible responses or same day appointments and new patients. Knowing a patient’s eligibility status prior to their appointment is one of the easiest ways to ensure a speedy reimbursement.

  • Supporting timely charge entry: A quick turnaround between the date of service and the date of claim submission to your clearinghouse is crucial to a healthy revenue stream. I recommend trying to submit claims within one to two days of seeing the patient. A great way to measure if you are meeting this timeline is to look at your claim submitted dates and compare those to the dates of service on the claim. If you notice a large gap in time between those two dates, search for the reasons behind that gap. For example, look for common sources of the problem (i.e. same location, provider or payer). Once the root of the problem has been identified, you can make the necessary changes to shorten the lag time and improve payment turnaround.
  • Maximizing electronic payers: It is important to know which payers allow electronic claim submission for primary and secondary claims as well as those that provide ERA and EFT. Sending claims electronically, instead of on paper, drastically reduces the time it takes for the claims to reach the payer and a response to be received. The same can be said for ERA and EFT; by receiving payment and EOB’s electronically you no longer have to wait for the mail to arrive before a payment can be posted or to follow up and/or start the appeal process. In addition, electronic transactions lend themselves to better tracking, transparency and research, which provide the information needed for deeper analysis on rejections and denials.

Ultimately every practice is in search of strategies to get money in the door faster. By maximizing electronic payers, leveraging eligibility and ensuring timely charge entry, you will be well on the way to making that happen.