According to MGMA, a resounding 82.8% of practices they’ve interviewed have experienced employee fraud/theft. In 28.7% of those occurrences, the Practice Administrator or Billing Manager was the perpetrator. In 25.9%, the receptionist was the perpetrator. Most commonly, the fraud relates to theft of receipts, theft of cash, or altering/forging checks.
As a billing company, we’ve spoken with countless practices whom, at some point or another, have been the victim of employee theft. The most frequent occurrence relates to cash payments. Most practices do not have enough controls in place to ensure transparency within their operations. The same employees often handling the cash are the same employees entering transactions. It becomes very tempting and very easy to key payments, settle balances, or remove obligations from accounts once the patient has paid.
Can it happen to you?
Over the past year, we began working with a client, whom was a sole practitioner, who had two staff whom she considered trusted long term employees working in her office. Within weeks, we began noticing a trend which later proved to be a case of theft by the front desk employee. This had been ongoing, unbeknownst to the practitioner; however prior to partnering with iATROS, it had gone un-noticed. How’d we do it?
From the origination of working with a practice, we establish two controls.
1. We do not handle any paper money, ever.
2. We utilize our own state of the art practice management system, and our internal staff are the only users allowed to reconcile balances on any accounts.
By design, these controls separate those who are handling paper money, from those who are recording paper money. This design increases transparency, as well as ensures the integrity of the data for your patient accounts.
In the case of the example above, we removed the capacity for our client’s staff to edit or manage the recording of funds for any accounts. The perpetrator continued to pocket cash payments from patients paying up-front; meanwhile they were not reporting the cash payments to us. Naturally, we continued to contact patients to collect funds, through statements and phone calls. It was only a matter of time until we encountered enough patients whom had paid their balance, yet were still being pursued for payment. Working with our client, we were able to identify the perpetrator and they were then able to take the necessary steps on their end to remediate the problem.
What can you do to minimize your risk?
Separation of Duties: Ensure those staff who are receiving cash payments, do not have the authority or capacity to key or manipulate the records.
Ensure each and every patient who makes a cash payment, receives a written receipt. This should be a written policy in your practice, and your patients should expect to receive a receipt upon payment. If you do not have the technology to print a receipt, which stores a record on your behalf, purchase a receipt book from an office supply store which records a duplicate for your records.
Read the full MGMA study at: http://www.mgma.com/WorkArea/DownloadAsset.aspx?id=40054
30% of physicians didn't accept new Medicaid patients in 2011. With an expected 30 million people to gain health insurance through health reforms new health insurance exchanges and expanded Medicaid programs in 2014, questions have to rise about the capacity for our healthcare system to accommodate this influx. http://www.healthcarefinancenews.com/news/three-ten-doctors-2011-didnt-accept-new-medicaid-patients
Do you know how much money your practice should be generating? Or as long as there is money in the checking account, are you satisfied?
Every day, I encounter physicians who have no idea how much money they should be making. Even worse, I meet several who simply don’t seem to care. How much money should you make if you see 15 patients on an average day? Do you really know? Sure you can look at your bank account average. Or you deduce from your total charges what your allowed amount should be roughly.
If you’re apathetic to being able to answer the question of how much you should be making, then your staff is too. MGMA estimates practices commonly leave over 20%-25% of their revenues uncollected. As higher deductible health plans continue to thrive, this # will go up.
What can you do to ensure your practice is financially optimized?
- Weekly Forecasting: Monitor your total charges and total claims filed each week. Charge totals provide insight into productivity levels, but also allow you to “estimate” the bulk of projected payments due to your practice over the next 15-45 days.
- A/R Management: You should be capturing 95% or more (90%+ for family practice/Internal Medicine) of your insurance due funds within 120 days. If you’re not, you’re losing money, period. The value of a dollar decreases each passing day. The longer you go without capturing that money, the greater the likelihood you’re not going to increases. Oh, and watch your write-offs…
- Write-offs/Denials: You’re likely not doing your billing. Who is? This person needs to be trusted like your accountant. If the same person managing your claims has the ability to write off any/all funds without your approval, you’re setting yourself up for losing money. Audit your write-offs and I guarantee you’ll find easy money lost. Writing balances off and poor denial management go hand-in-hand. Not to mention, if your staff messes up, i.e. fails to bill a claim within the timely filing limit or mistakenly completes the claim, its way too easy to write that balance off rather than pursue it or admit their error. Run a detailed adjustment report once a month, at a minimum. And audit random accounts, you’ll be glad you did.
- Periodic Billing/Coding Audits: Every 6 – 12 months, (more if you transition through staff), pick two random days from 120 – 180 days prior. Select the appointment register for that day, the correlating super bills you completed, and the EOB’s returned for those specific encounters and review each against your one another.
- Were all the patients accounted for? Do you have EOBs or payments posted in your practice management software for each patient? If not, is there a posted reason why?
- For any denials, why were they denied? What did your staff do to resolve the denial?
- What balances or portions of balances were written off? For what reason code where they written off?
- For those patients, what % have paid or made a payment? How many statements has your staff logged as being sent?
- Did all CPT’s and corresponding ICD-9 codes get billed and were they correct? What % were not or were missing?
- For the no-shows, how many of those patients rescheduled? Did they re-schedule? What is your follow up policy for no-shows?
These are just a handful of ways you can ensure your practice is generating the revenue it should. If you’re not doing these steps, you’re not alone, but unfortunately, you’re not running your practice like an efficient business either. As the volume of higher deductible health plans increase, HMO plans increase, and payers continue to cut reimbursement, it will be imperative to your success to focus on these areas or to employ financial experts like iATROS Healthcare Solutions to help you optimize your finances while you optimize your patient care.
REMINDER! The CMS Office of E-Health Standards and Services has released a reminder to the industry that the end of its enforcement discretion period is quickly approaching. As of June 30th, 2012, "covered entities are required to comply with the updated transactions standards adopted under the Health Insurance Portability and Accountability Act of 1996 (HIPAA): ASC X12 Version 5010 and NCPDP Versions D.0 and 3.0." Once this date passes, organizations that have not taken the proper steps to become compliant will be subject to enforcement under the existing HIPAA transaction enforcement process. If you would like to speak with a professional regarding the enforcement of HIPAA 5010 and/or your level of compliance, please contact iATROS Healthcare Solutions today, our healthcare experts are standing by to help you assess the health of your practice.
iATROS Healthcare Solutions will be exhibiting at the 2012 FICPA Healthcare Industry Conference, held April 26th through 27th at the Hyatt Regency in Orlando, Florida. This is the perfect conference for any CPA who works with physicians, clinics, or hospitals so stop by our booth to learn more about how our revenue cycle management solutions can assist you and your clients in optimizing their revenue.
Please click the image above to learn more about the FICPA Health Care Industry Conference.
The capability and proficiency of a professional billing company in a physician's practice is a critical factor in the speed at which you get paid. Revenue cycle management is a continuous process that needs to be attended to constantly and in an efficient manner. When it comes to maximizing reimbursements from insurance companies, the billing company entrusted must have an established, effective process in place. How does your billing company stack up?
The success of a physician’s practice is dependent upon its ability to maintain financial stability, which is accomplished by using a competent billing company. Your billing company must have a trusted process in place for the entire revenue cycle. These processes will ensure that payments are timely, as well as reduce billing burdens. The right medical billing company will:
- Reduce the burden on, or eliminate the need for, internal billing staff
- Minimize administrative costs
- Help maintain positive patient rapports through efficient billing
Verification of Insurance
A professional billing company understands that the revenue cycle starts before your patients arrive in the office and will stress that you institute an insurance verification policy for your patients. When appointments are made, the insurance information should be verified - every time. Even regular patients’ insurance information needs to be consistently verified because of member eligibility requirements. Below are some of the benefits of instituting an insurance verification policy prior to the arrival of patients:
- Pre-registration is more efficient
- Verification of covered medical services
- Clear co-pay and deductible ensures on-time payments
- Reduction of claim denials
- Prior authorizations mean less denial of claims
- Upfront payment means less collections efforts
Additionally, the payment process will go much more smoothly by notifying patients prior to arrival what their estimated financial responsibility will be. Patients should understand that payment is due prior to services rendered.
Prompt Denial Processing
A professional billing staff can also facilitate the requirements from most insurance carriers to pay claims or provide denials within the timely filing limit. Claims not processed within this time period are subject to penalties or denials. Billing professionals take over the entire follow up process and take a proactive approach to processing claims and/or denials to substantially improve your A/R. The medial billing company may utilize the following denial processing strategy:
- Follow up on electronic claims in 10 business days
- Follow up within 15 business days of paper bills
- Ensure that claims were received
- Ascertain whether claims have already been processed.
Payment Review Process
The last step in the physician revenue management cycle is reviewing payments for accuracy. Ensuring that full reimbursement is received, according to the insurance contract, is a key factor in your revenue cycle process that your billing company will handle. All payment inconsistencies should be handled and/or addressed promptly to resolve them in as short a time period as possible.
With a billing company that has an efficient process for each of the above aspects, it is much more likely that your revenue cycle process will yield greater reimbursments, which means more success for your practice.
Would you like to learn more about how partnering with iATROS Healthcare Solutions can maximize your revenue cycle? Contact us today for your free performance analysis and at no cost to you, we will simply help you answer:
Can it be better? How much better? Better at what cost?
Maximizing patient collections requires that medical practitioners take a hard look at their billing procedures and payment options in order to discover ways to resolve common patient payment issues. Typically, maximizing the collections process will require that you streamline and change your current office processes and payment acceptance program.
One way to maximize patient collections in your medical practice is to create a payment policy that clearly outlines to your patients your expectations in regards to timely payment and the types of payment options available such as insurance or financing. If you don't have a policy in place and you expect payment at the time of service, a patient can claim that he didn't know or understand your payment expectations. Instead of an immediate payment, it may take weeks or months to collect on the bill, or worst case, never.
Include payment arrangements as part of your financial policy, such as a discount to any patient who agrees to pay cash up front or a multiple payment option to patients who can't pay their bill because of financial hardship. When setting up a multiple payment option, design the plan to help patients pay at the level they can afford while still helping you to collect on their bills in a timely fashion. Treat the arrangements like a loan with a set term such as 6 or 12 months and a minimum payment amount.
Establish a patient collections training program for your front office and billing staff that clarifies any questions about the payment policy and establishes your expectations in regards to how your employees should address the policy with patients and deal with situations that can cause payment delays. During training, discuss with your employees ways to announce and post the policy such as hanging a sign that outlines the types of insurance you accept and handing out or emailing copies of the policy to new patients. Ask your employees to role play various types of patient collection situations that have posed challenges to them in the past to brainstorm ideas of ways to quickly resolve issues.
Monitor Your Progress
Monitor the performance of your patient payment policy on a regular basis. Allow a couple weeks for changes to take effect then begin evaluating how well everything is working. Be sure to gather information on collections rates from the weeks and months prior to your changes and then compare the data to the weeks following. If something doesn't seem to be working, don't be afraid to change it. Especially in these inital stages, you must manage the new policy and make additional changes where necessary. And remember, maximizing your patient collections is an ongoing process, but if done right, it can yield drastic improvements in your revenue cycle.
Want to learn more about streamlining your patient collections process and optimizing your revenue cycle? Initiate your free practice analysis with iATROS Healthcare Solutions and find out:
Can it be better? How much better? Better at what cost?
Due to the current challenges surrounding the management of medical practices, challenges that are constantly exacerbated by government requirements, financial limitations and new technologies, practice owners find themselves continually faced with a decision on which operation methods are most cost effective and generate the most revenue. Whether to use in-house medical billing or not is one such decision. Below are a few advantages and disadvantages of this system.
· Greater control over day to day billing activities. Questions are addressed in real time and changes are implemented promptly, all on your watch.
· With in-house medical billing, the practice has more control over client’s private health records. A company's reputation can be ruined if its patients' medical records are leaked to unauthorized parties or compromised in any way by a third party billing provider.
· Some outsourced companies may be reluctant to go after small balances. The company can lose significant amounts of money if these small balances are allowed to accumulate. Having an in-house billing department can help collect such payments in a consistent manner.
· High start up costs - Depending on how big your practice is, your billing department may consist of two to three trained billers for every three providers. Apart from payroll expenses, the average start up cost of an in-house medical billing department includes equipment, software, registration with a clearinghouse, more space for storage of records and the cost of reference materials like annual coding courses or books.
· Inadequate Human Resources - It's not easy to find employees with adequate medical billing experience. It is possible that when starting out, you employed a few people with some medical billing experience who have over time, grown into the job and have become very experienced. Sadly, the possibility of losing them is very real. Replacing a billing specialist has to be done instantly if you are to maintain the cash flow, which could end up forcing you to hire inexperienced employees.
· Employee costs - The cost of employing a team of in-house billing specialists can be quite high. Apart from paying them, the practice has to cover their healthcare, benefits, federal and state employee charges among other expenses.
For a small practice, it may be sufficient to use an in-house billing department, but as your practice grows, revenues will increase exponentially as will the medical coding and billing workload. Whether you currently process claims in-house or outsource, now is the time to ensure you’re set to maximize your practice’s revenue.
The experts at iATROS Healthcare Solutions can guide you to success. Our team of professional claims managers, financial analysts, and collections professionals will review your practice to evaluate how well things are working and what areas need your attention. The best part is, we do this all for FREE! Contact us today for your free practice analysis!
The looming compliance deadline has come and gone. Beginning on January 1, 2012, the health care industry begun implementing HIPAA 5010, and HIPAA covered entities are now required to conduct electronic transactions using the 5010 upgrade. This includes eligibility, claims submission, referral authorizations, remittance advice and other electronic transactions performed by covered entities. Institutions that haven’t been impacted by the challenges of the transition will soon begin to notice increased claim rejections in the coming months. Below are best practices for becoming compliant to avoid rejected claims, payment interruptions and other industry challenges.
Learn how the 5010 format will impact new claims data
Although your clearinghouse or vendor can assist in converting your claims to adhere to the 5010 standard, the data used is still provided by your institution. For example, submitting claims that do not include the correct address and zip code requirements will not be converted and sent for payment. Reaching out to other practices within your specialty will help you to identify possible challenges, and can provide resolution to those challenges without exposing your practice to the “pain” firsthand. When a rejection occurs, monitor the rejections while paying close attention to any address related issues (i.e. remittance, EDI), to ensure claims are reimbursed without delays.
Monitor rejection reports to identify these key factors (not an all inclusive list):
· Ambulance claims—pick-up and drop-off locations must be reported, as well as the number of patients transported in the vehicle.
· Drug reporting—claims for injected medicine must include additional drug information as well as the HCPCS code.
· Billing provider address—5010 guidelines mandate the need to enter the billing provider as the physical address. PO Boxes or lock box addresses will need to be reported as “pay-to” addresses, when needed for payments and payer correspondence.
· Zip codes—providers must now submit claims with a nine-digit zip code when reporting the location of service facilities and billing providers. This includes the five-digit zip code with the correct four-digit extension.
Conduct thorough testing, both internally and externally
All changes made will not go according to plan. Therefore, internal testing should be performed to determine if the software changes for implementing HIPAA 5010 transactions are functioning correctly. Testing will allow you to discover and resolve any possible system issues that could occur as a result of a 5010 transaction, and can help determine if a failure is internal or external. Two levels of testing include:
· Level 1 Testing: A practice is able to create and receive 5010 transactions successfully, within the organization.
· Level 2 Testing: A practice is able to send and receive 5010 transactions externally, with business associates, clearinghouses, payers and other partners, using the same channels as those used to conduct current transactions.
Encourage the use and expansion of automation
Automation can be used to improve the internal and external testing process. Automation allows completing these tasks in a shorter period of time with more consistency across the board. Creating scenarios to test the processes which are most vital to production will prove beneficial for time-strapped institutions, as opposed to testing every single scenario.
Although the Centers for Medicare and Medicaid Services announced that enforcement actions against non-compliant organizations will not take place until March 31, 2012, there is no breathing room remaining to become complacent. The entire HIPAA covered medical industry should begin implementing HIPAA 5010 by working with business associates and other collective organizations within the industry, to ensure successful testing and a painless transition. Refusing to move towards compliance now will inevitably cause administrative nightmares and payment headaches in the near future.
Does your practice have the proper measures in place for the implementation of HIPAA 5010? Find out today by initiating iATROS Healthcare Solutions' complimentary practice analysis.
This evening the Senate approved by unanimous consent a bill that will provide a 31-day payment patch to the Medicare sustainable growth rate (SGR) formula. The bill will freeze current rates for services provided through Dec. 31, and temporarily avert a 23 percent cut to physician payments that was slated to take effect on Dec. 1.
The House of Representatives has adjourned for the week. The representatives are anticipated to vote on the bill upon their return.
While the 31-day fix, if approved, is a step in the right direction, it is only a temporary patch. Physicians still face a 25 percent cut on January 1, 2011. MGMA continues to call for an additional 12-month fix to give lawmakers time to find a permanent solution. Additional member grassroots advocacy during December is necessary to halt the 25 percent cut on Jan.1. We will continue to keep you apprised as we receive further updates.Source: Washington Connexion