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Observation
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Recommendation
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Electronic claims are submitted once or twice
per week.
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Increase electronic claims submission
to three or four times per week.
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More than 20% of claims submitted are denied
due to incomplete data or incorrect coding.
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Determine the source of the
problem. Improve accuracy of patient demographic
information entered at check-in.
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Conduct staff training related
to problem areas.
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Identify rejected claims, re-work
them and resubmit filing within 30 days of denial.
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There is a significant amount of A/R in the
over 120 days aging category.
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Develop a work plan and immediately
focus attention to this area.
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Analyze these accounts by patient
and payer.
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As appropriate, write off claims
that are uncollectable or too small to justify
pursuing (follow current practice policy and
procedures).
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Send claims to collections and
remove from the A/R report (follow current practice
policy and procedures).
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Set goals to measure success.
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Reward success.
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There is lack of clarity on the part of staff
regarding billing and collection procedures.
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Ensure the practice has a current,
and well defined policy and procedures manual
for the business office. If no policy exists,
assign a team (one person from each department
involved in the billing process) to write the
manual.
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Conduct periodic staff training
to review the policy and procedures.
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Roles and responsibilities are not clear for
all positions dealing with accounts receivable.
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Develop or update job descriptions
for each position involved with the accounts
receivable process.
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Patient demographic information and insurance
coverage is not verified to be accurate at check-in.
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Train front-desk staff on the
importance of having accurate patient data.
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If possible, verify information
over the phone at the time the appointment is
made.
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Copy insurance cards at each
visit. Remind patients to bring their card with
them when appointments are confirmed.
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The team involved with accounts receivable
is not aware of the A/R status.
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Utilize a monthly A/R aging
report to communicate status by payer group.
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Communicate planned activity
to address current issues and involve team members
in the activity.
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Establish departmental goals
for collection ratios and days sales outstanding.
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Consider use of incentive plans
as a means of rewarding outstanding performance.
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