Cover Story

PRACTICE POINTERS

Scoop up every dollar you've earned

Payers have devised dozens of ways to deny or delay reimbursement. Is your practice doing enough to fight back?

By Deborah A. Grandinetti

Last year, a four-physician ob/gyn group in Germantown, TN, brought in an extra $250,000 by getting more aggressive about billing. Among the winning strategies: replacing three billing employees with more-capable people, investigating why claims were denied instead of simply refiling them, and training the front-desk people to capture all information needed for claims at the time of scheduling—including verification that the requested service would be covered.

By year's end, the gross collection rate increased by 3.6 percentage points, says Steve Coplon, a Memphis consultant who worked with the practice on the billing improvements. The staff had also brought down the average age of the practice's accounts receivable from 120 days to 60.

Perhaps your billing operation could benefit from a similar overhaul. The key to getting what's yours from insurers, says Coplon, is to instill a "war room" mentality among your billing staff.

"Assume payers are going to do everything they can to downcode, delay, or deny payments," he says. "You need aggressive, persevering employees who realize they're entering a battle and won't give up—people who aren't satisfied until they get those dollars in."

"It is a contest," says Larry Deblinger, a former collections consultant. "I think managed care organizations make their systems deliberately inefficient. They're banking on the probability that enough doctors will be unable to substantiate their claims. The challenge is for your practice to be so efficient, so persistent, so thorough, that you finally knock them down by sheer force."