As manager of collections and reimbursement for Radiation Oncology Services of America (ROSA, Inc.), I am constantly thinking about ways to enhance the collections process and speed up reimbursement. Although there are many good practices worth considering when trying to improve the reimbursement process, the following are a few I’ve found to be most beneficial:
- Foster good relationships with front end staff. Our organization has a centralized billing office that works claims for all of our 16 radiation therapy locations. This means that we at the billing office are geographically separated from the clinics with which we work. Because of this, it’s critical we maintain a good working relationship with front end staff based on mutual respect and effective communication. That way, everyone is on the same page about what is needed to support a clean, efficient, and successful claims process. For example, a good working relationship helps ensure that front desk staff understand the importance of collecting and sending accurate patient demographic and insurance information.
To cultivate this relationship, our organization offers a lot of education for front end staff on billing, coding, and charge capture. This is done through monthly emails, onsite training, and the opportunity to periodically shadow central billing office staff for a day.
- Allocate work by payer. This allows our collections staff to become “specialists” with regard to a payer; they grow to understand what a particular payer will and won’t accept, and how to prepare claims according to the payer’s preferences. This also encourages trend identification and prompts staff to work with payer representatives to address any negative trends—therefore avoiding future rejections and denials.
- Leverage claim editing software. Our system allows us to catch problems with a claim before it’s uploaded to our clearinghouse and sent on to the payer. By noticing and addressing edits proactively—such as adding necessary modifiers that are inadvertently left off—we can ensure the cleanest claims are sent off for payment.
- Know your specialty. Radiation oncology is a very specialized field. Payers have certain ways of responding to and paying our claims that we have come to expect. Other specialties—like pediatrics, orthopedics and ophthalmology, for example—have their own specific characteristics that may influence the way a payer reimburses. By knowing our specialty and our payers, we can anticipate issues and understand how to most appropriately prepare claims. We can also understand why payment may be delayed in certain circumstances. I make a habit of looking at payer policies each month to review any changes in payer coverage for the services we provide. This helps me keep on top of new developments and respond to them accordingly.
Although there are additional ways that practices can improve the reimbursement process, these are ones that I have found most effective for my practice. What tactics has your organization found effective?