Coding Checklist: It's Time to Update Policies and Procedures

Throughout the course of a year practices may find it necessary to modify policies and procedures, and they should never feel restricted by arbitrary deadlines (such as the first or last day of a month) to implement needed changes. However, the beginning of the year is an ideal time to scrutinize policies and procedures and implement changes (although periodic reviews are ideal). People—your staff, patients, vendors and partners—are accustomed to changes in the new year, so they may anticipate and respond more readily to changes at this time.

Collection of Patient Responsibility
My company, DermResources, has always recommended a strong, sound financial policy that includes collection of patient responsibility at the time of service. This is a cornerstone of an efficient practice. As costs climb and deductibles continue to rise, now is a good time to make changes toward the goal of 100 percent collection of patient responsibility at the time of service. Achievement of this goal requires advising patients of their responsibility in advance of the office visit as well as allocating staff to get the preliminary work done.

First make certain you have current fee schedules from all of your payers. This will allow you to calculate the appropriate amount to collect from the patient at the time of service, based on their insurance company's fee schedule. Next, enroll the practice in internet services that provide information on the status of the patient's deductibles, co-insurances, and co-pays. Most of the large insurance companies have this type of web access, and in some areas there are services that access more than one company.

Access is also available through some claim filing clearing houses. The practice must enroll to have access, and access is then controlled by password. When the information is obtained, it is then provided to the check out personnel to facilitate accurate collection at the time of service. For a few payers, phone calls will be necessary.

Patients must be advised in advance of the new policy. This can be accomplished by mailing letters, although this is an expensive process. Alternatively, the information can be given to patients as they schedule appointments or as appointments are confirmed.

It may be necessary to hire a part time entry level person (or full time depending on the size of your practice) whose responsibility is to gather the information about patient responsibilities and communicate that information to the patient in advance. To determine whether this staff addition will increase your costs, take a look at your accounts receivable report. If there are numerous patient due amounts over 90 days old, it is worth the hire.

Current employees may be able to add the benefit checking to their current duties, or this service can be outsourced. Provider Reimbursement Services (850- 450-8081; DermResources is affiliated with them) is one such company.

Toward 100% Collection of Patient Responsibility
1. Gather current fee schedules for all carriers.
2. Advise all patients of the practice's up-front collection policy.
3. Determine patient's deductibles, co-insurances, and co-pays.
4. Notify patient of his/her responsibility in advance of visit.