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Improving Your Clinic’s Speed of Reimbursement
Panelists
Andrea Jolliff, EDI System Analyst with Valley Medical Center, PLLC
Hanny Freiwat, Co-founder and President of Wellero
Jeff Whiting, President and CEO of Alta Medical Management
Shelley Bull, CPC, Business Office Manager/Team Leader
Kellie Armijo, Senior Implementation Consultant with HealthCo information Systems
Debbie Tomlinson, CCSP, CPC, Business Office Supervisor
Poll Questions
Payment Cycle
Prior to Visit &Registration
Building and Submitting Claims
Denials and Reporting
Prior to Visit &
Registration
Prior to Visit &Registration
Pre-register online through patient portal/motivate patients to engage with portal
Verify patient insurance eligibility/benefits/pre-authorizations
Add patient alerts on account if needed
Prior to Visit &
Registration
Provide front office staff with proper training and tools
• Staff scripts and audits
• Proper data entry
Discuss “alerts” if noted on account
Discuss patient financial responsibility
Discuss clinic financial policies
Help front desk staff understand carrier allocation sets
Develop dashboards for front desk staff to track payment activity
Prior to Visit &
Registration
Building and Submitting
Claims
Educate the staff that inputs codes• Customizing forms• Helpful “pop-ups” • Forms that include charge sets
Specificity and locality for the code
Correct linking to CPT codes
Make it easy for physicians to enter charges at the time service is performed
Correct use of modifies on CPT codes and appropriate CPT code order on visit
Building and Submitting
Claims
Utilize claims manager software and charge sets
• Pre-scrubbing claims before submission• Cleaner claims = less denials
Monitor daily batched claims
Send all claims electronically if possible
Utilize electronic remittance posting
Building and Submitting
Claims
Establish a collection process
Develop audits for all payment posting
Denials & Reporting
Work denials within 24 hours of payment posting
Report back to staff on denials to eliminate future reoccurrence
Utilize Task Management or Visit Owner
Utilize a claim scrubber software
Utilize a denials predictive software to show where they may occur
Batches closed timely along with month end close
Review trends / employer data
Denials & Reporting
1. Motivate use of Patient Portal for registration and payment
2. Perform eligibility verification at least 48 hours in advance of visit
3. Prepare your staff with training for THE CONVERSATION
4. Discuss and collect patient responsibility up front based on eligibility checks
5. Embrace software tools for claims scrubbing, submission and denial prediction
Top 10 Things You Can Implement TODAY to Improve Your SPEED of Reimbursement
6. Build internal processes to manage billing and collections
7. Encourage a feedback loop to staff on denial activity
8. Share clinic receivable/financial information across all roles that impact it
9. Utilize reporting tools to look at daily, weekly, monthly trends
10. Find the right software to partner with to eliminate human “error”
Top 10 Things You Can Implement TODAY to Improve Your SPEED of Reimbursement
Resources• HealthCo Blog on reducing denied claims
• Information on preventing claim denials with Denials IQ from GE
• Slide deck on Slideshare
• Panelist Contact Information
