TEAMWORK BY THE NUMBERS:
Getting the Most from Your Accounts Receivable Team

Who manages the Accounts Receivable in your office? Depending on the size of the practice and how it is structured, it could be the Accounts Receivable Manager, Coding Specialist, Office Manager or all three wrapped into one position.

Although the Accounts Receivable may be managed by one person, it is important to realize that each and every person in the office is a member of the "AR Team" and is capable of affecting the AR positively or negatively.

So, who's responsible for what?

Since the physician/provider actively manages the face-to-face encounter with the patient, he/she is the logical person to code for services provided. Coding involves the selection of the proper level of evaluation and management service according to CMS guidelines and/or the selection of procedures performed. In both cases, the selection of diagnosis codes is crucial. They should justify medical necessity for the service/procedure, otherwise, the practice is at risk for being downcoded by the payers for E&M services or being denied payments for procedures.

If hospital procedures are to be billed on a timely basis (preferably three to five days from the date of discharge), the physician/provider must complete dictation promptly. Surgeries cannot be coded and submitted until the operative notes are received. Delayed dictation causes claims to age weeks (or longer) before being submitted for payment.

All services rendered must be captured. It is important to avoid omissions and to fully complete the encounter form. If this is a problem in your office, you might consider having the nurse review and initial the form for completeness.

One last important role for the physician/provider is to be approachable and available to the staff when there are questions or concerns.

Nurses need to understand when to charge for nurse visits and when to bill for injections only. Nurse visits are provided under the direction of the physician/provider and documentation of the physician's order must appear in the patient chart. When a patient visit is strictly for an injection, the nurse may bill only for the administration of the injection and the drug injected.

Nurses are also instrumental in obtaining Advance Beneficiary Notices (ABN's) from Medicare patients. If these waivers are not obtained and Medicare denies the claim, the practice may not bill the patient for the service. Certain services are not covered by Medicare at all and others are limited due to time frequency guidelines. By staying abreast of industry standards, the nurse can help to ensure the practice receives payment for these specific services.

And finally, the nurse should flag the patient file anytime a procedure with a global period is provided. It should simply state the procedure provided and the date the global period ends. This will alert the physician/provider to use a modifier (if applicable) when a patient returns during the global period for a service unrelated to the procedure. Otherwise, the claim could be denied.

The Front Desk staff has a dramatic impact on the AR. If patient demographics are entered incorrectly, insurance eligibility checks are not run or authorizations/referrals are not in place, the claims could be denied. Reminder calls for appointments are still the best way to avoid costly "no shows." And most importantly, if they do not ask for the payment, they won't get it! Effectively collecting co-pays, copayments and deductibles is essential.

Of course, the Accounts Receivable Manager is primarily responsible for the receivables . Financial pre-ops are essential for major procedures to obtain signed surgical contracts and deposits PRIOR to surgical procedures. Daily priorities should include running claims and statements (to prevent unnecessary aging and increase cash flow), payment posting (to ensure balances due roll to secondary insurances or patients expeditiously), coding surgical/hospital services and follow-up on denied claims. Delinquent accounts should be transferred to collections like clockwork. Third party intervention is most effective and by the time an account ages three months, the chances of collecting drop by 26%.

Unfortunately, when team members make mistakes, the AR Manager's job becomes immensely more burdensome. It is up to the Office Manager to ensure each team member understands his or her contribution to the bottom line, monitor the team's performance and detect and correct errors so they are not continually repeated.

When everyone on the team understands their individual role and appreciates the roles of others, the team will flourish and so will the AR. So take the time to pull your team together, motivate them, troubleshoot, reward good performance and keep the lines of communication open.