1. Achieving Success with Billing and
Collections
Presented By:
John R. Mazza, President/CEO
Financial HealthCare Management, Inc.
1400 Johnson Avenue, Suite 4-S
Bridgeport, WV 26330
PH: 304-842-0307 Fax: 304-842-0315
Web: www.fhcm.net Email: jrmazza@fhcm.net

2. BE PROACTIVE
Being Proactive Means:
 Practices ensure that patient demographic and
insurance information is correct, so claims can be filed
right the first time.
 Practices collect from patients at the time of service
whenever appropriate, to prevent financial losses after
care is provided.
 Staff has the information needed to facilitate patient
education and fulfillment of insurance plan-mandated
rules and paperwork.

3. Electronic Resources for Confirming Patient
Eligibility and Benefits
 Use online tools to check patient insurance
eligibility and benefits, co-pay amounts, referral
requirements and claim status.
 Armed with this information, your team will be
able to file the claim correct the first time.
 Local Carriers currently offering this service:
(The Health Plan, Workers Compensation,
Acordia, Tricare)

4. Time of Service Collections
 Consistent co-pay collection is a basic
step that can have a big financial impact.
 Creates immediate cash flow and
eliminates the cost of collecting from the
patient in the future.
 ACCEPT CREDIT AND DEBIT CARDS!!

5. Enforce Audit Controls
 Simply translated, an audit control is a process
used to ensure that all of the services
performed, and all of the payments collected in
the practice, are properly recorded in the
practice’s computer system and balanced to the
bank account. A lack of audit controls is a
common finding in practices that have
experienced internal theft or embezzlement.

6. Perform a Daily Close (Key Steps)
• Services and payments are recorded on the encounter form,
reflecting the value of the service and amounts collected from the
patient.
• Services and payments recorded on the encounter forms are
tallied manually prior to data entry, so they compared with the
information system totals after data entry.
• Manual or electronic encounter forms are reconciled to the day’s
appointment schedule to ensure that all services scheduled and
performed are turned in for billing.
• Payments received in the mail are tallied by an individual other
than the specialist who enters them into the information system.
Any variation between the two values must be reconciled.

7. Lockbox Solutions
 A lockbox is a fee-based service offered by
many banks, whereby payments mailed to the
practice are directed to a bank-managed post
office box. Upon receipt at the bank, payments
are deposited, photocopies of the checks are
attached to the original EOB remittances, the
EOBs are tallied in batches, and the batches are
forwarded to the practice. Upon receipt in the
practice, payments are posted as usual.

8. Track Missing Charges
 Whether managed through a printed
report or viewed from the computer, the
missing encounter list must be monitored
daily to highlight scheduled encounters
that did not have a corresponding service
posted.

9. File Claims Fast
 Once a service has been provided, every day
that a claim remains unbilled is one less day that
you have access to the revenue for that service.
 Payers continue to impose filing deadlines of as
little as 30 days from the date of service.
 Failing to file a claim within the designated
period can result in a claim denial, and the
practice cannot collect from the patient.

10. Develop Efficient Charge Capture Tools
 Physicians in all specialties are using
personal digital assistants (PDA’s) with
charge-capture programs to streamline
hospital, surgical and office billing.
 In less technologically advanced
practices, simply developing a hospital or
surgical encounter form will assist the
billing staff in getting claims billed
promptly.

11. File Electronically When You Can,
and Work the Electronic Edits
 Despite the prevalence and acceptance of
electronic claims, we continue to see practices
relying on paper claims. MAKE THE CHANGE !
 For practices currently submitting electronically,
your staff should be working the electronic edit
report daily. This report highlights claims that
contained errors and were rejected by the
electronic claims vendor.

12. Reinforce Timely Filing Deadlines and
Track Adjustments Retrospectively
 Do not let your practice be subject to
losses that can be prevented with
physician and staff education.
 Post lists of payer filing deadlines.
 Track and monitor the dollar amount of
any claims denied for reason of “Timely
Filing” each month.

13. Use Electronic Remittance
 Electronic remittance is a process
whereby payments and adjustments are
conveyed back to the practice’s
information system electronically from the
payer, eliminating the need for manual
data entry.

14. Process Patient Statements
Bi-Monthly
 Processing patient statements in bi-
monthly batches, instead of one large
batch each month helps the practice to
even out the patient question calls that
result on receipt of their bills.
 Cash flow can also improve and become
more predictable and consistent.

15. Review and Correct EOB Denials
Promptly
 The first step in managing patient
accounts is to review and resolve the
claims that are highlighted in EOB
remittances returned unpaid by the
insurance carriers.
 Don’t spend hours on the phone
researching the reason for denial. The
answer is usually on the remittance.

16. Follow up on Accounts by Age and
Dollar Value
 Get the best and most return for your
effort.
 Work accounts by highest dollar claims.
 Work accounts by time sensitive payer
types.
 Inquire about multiple claims on the same
phone call or check claim status
electronically on multiple accounts from
the payers web site.

17. Don’t Forget to Work Credit
Balances
Credit balances are a two-pronged
problem for practices.
• First, they understate the value of the
accounts receivable by offsetting
unresolved accounts.
• Second, they represent a liability to the
practice; if claims are paid twice by
insurance carriers or patients, that will
money will need to be refunded.

18. Train and Educate
 Coding and modifiers. Are claims
being denied as bundled, lacking medical
necessity or lacking supporting
documentation? Do EOB’s show line
items with zero payment? Have those
responsible for coding ever attended a
formal coding workshop focused on your
specialty? Do physicians understand
evaluation and management criteria?

19. Train and Educate
 Reimbursement guidelines. Does
staff have access to tools that outline
payer reimbursement guidelines (e.g.
Medicare’s Correct Coding Initiative,
Medicare Part B News and other carrier
bulletins) to effectively direct their appeal
efforts?

20. Train and Educate
 Information system. Has staff received
updated training from the information
system vendor on system features and
reports? Does staff respond, “We can’t
get that from the system,” when you
request data related to billing and
collections? Does staff have access to
automated coding programs that eliminate
the need for multiple manuals?

21. Train and Educate
 Internet. Does staff have access to
Internet-based resources that will support
their efforts to be proactive and efficient?
Is the team trained to navigate the Web to
access Medicare and other payer
guidelines?

22. Monitor Results “Key Indicators”
Gross collection percentage. Helpful
internal measurement of contract
profitability; not useful in benchmarking to
others.
Total Receipts – Refunds
Total Charges
Target Level: Varies based on fee schedule
and payer reimbursement levels.

23. Monitor Results “Key Indicators”
 Net Collection Percentage. Measures
success in collecting collectable dollars.
Total Receipts – Refunds
Total Charges - Contractual Adjustments
Note: Collection Transfers and Bad Debt Write
Offs should not be included in Contractual
Adjustments total.
Target Level: 95 – 100 percent

24. Monitor Results “Key Indicators”
 Days in Receivables. Measures how
long, on average, it takes to get a claim
paid.
Total Accounts Receivable
Average Daily Charges*
*Total Charges/365
Target Level: 30 – 45 Days. (Based upon
payer mix and mandated claim deadlines)

25. Monitor Results “Key Indicators”
 Percentage of A/R over 90 Days.
Shows relative age of accounts
receivable; as accounts age they become
more difficult to collect.
Accounts Receivable Over 90 Days Old
Total Accounts Receivable
Target Level: 20 – 25 percent or less

26. Conclusion
 Set clear goals and expectations to your
staff.
 Provide necessary training when errors
are identified.
 REWARD exceptional and consistently
good staff efforts.
 GOOD LUCK AND THANK YOU