Make some billing resolutions for the new year

As we enter 2023, let’s consider some new, good habits we can start in our billing departments. By no means is this an all-inclusive list; rather it’s a place to start.

1. Provide patient-friendly payment options: Many of the EHR/practice management software systems out there now provide a way to text or email patients a payment statement with a clickable link. I can tell you, when my doctor’s office sends a bill via a simple payment system, I am much happier than having to log in on my own and pay with a credit card, call the office to pay, or, even worse, write a check. If your EHR system does not offer this, most likely your patient management system offers a HIPAA-compliant method as well. This is another way to collect payment in a timely manner, as required by your insurance companies. Not collecting co-payments could be considered an inducement, which is against the provider contract.
2. Review the Explanation of Benefits: Look over these files from the past quarter for insurance non-payments that are repeating, either due to errors on the side of the insurance company or on the part of your team. I hear almost weekly from colleagues about insurance companies paying incorrectly because of what is later explained to them as a “glitch in the system.” There are also several occasions where colleagues have had employees who failed to follow-up with the insurance company about a denied payment, saying they would ask about it “someday.” These non-payments could be costing you thousands of dollars.
3. Be sure patients are billed correctly: Your team should tell you as soon as they see discrepancies in the explanation of benefits, so that the same mistakes are not repeated before you have a chance to correct them. For example, an insurer once notified us their plan gave patients an allowance for glasses, as a new benefit. The first time we billed for this benefit, we found the company had a glitch in its system and the allowance was not a benefit. Thankfully, we watched for the payment and made the insurer explain when it was denied. We had the remaining patients who had been told of this “benefit” call the insurer for an explanation before we processed their orders.When billing, your office can go after the patient for money that is due, however, doing so doesn’t build a great practice-patient relationship.
4. Review your protocol for pulling authorizations: Once you’ve reviewed this yourself, go over it with your team and detail the process for patient benefits and collecting fees from patients. If you don’t, one person can incorrectly train a second person, who then trains a third, and we all know where that leads. Make certain your team knows what to do when they don’t understand the policy and benefits, and whom on your staff they can ask for an answer. Unfortunately, many of these questions pop up unexpectedly from patients, and they expect us to know the answers even though they’re different for every insurance company.

START 2023 RIGHT

Think back to all the clean-up work you did in your billing department during the down time we had in 2020. Most of us put new protocols in place. Now is a good time to check in and review those policies for yourself to be sure they are being followed, and to see whether they are working.

Starting 2023 caught up on billing will not only keep your patients happy, but also your team and bank account. OM

DR. JASPER practices in West Palm Beach, Fla.. She is an American Academy of Optometry fellow and is chief optometric editor of Optometric Management. Email her at april.jasper@pentavisionmedia.com.