I felt compelled to respond to the article with the following letter:

“I enjoyed the article by David M, Jaspan, D.O. That I have written over and over in my head as well as lectured to offices for which I consult and bill. As a billing service and managed care consultant, (self-employed) I have often found myself between the insurance company and the doctor. While it is true that some plans are more doctor friendly than others, it is also true that the insurance companies are not always the worst enemy we have. I continuously stress to my clients and their staffs that they are the first ones touching the superbill, charge slip, routing slip, encounter form. The cleaner it is, the more advanced it is in using modifiers and trying some add-on codes that are clearly described in a CPT book/computer program the better the chance to see an improved cash flow. I also try to stress that correct is better than quick, having seen my share of superbills prepared that are sloppy and incomplete in the doctor’s haste to just get them our the door to me to do the billing from my off-site location”

After 14 years in this business on my own where I rely on a salary based on the doctor’s receipts I have no choice but to employ strict policies for myself as well as the offices with whom I have enjoyed long term relationships. And when you call insurance companies as much as I do, it helps to know what I am talking about regarding clean claims.

Fran Glucroft
Medical Office Manager
Fairfield, CT

Okay I say- now what are you going to do with this report? The dedicated staff person might start to go through this report one patient at a time and start to dissect each category to figure out what is due from insurance and what is due from patient. This could take your billing person the entire month and after a while one account looks like the next which leads to a very inefficient process and an overwhelmed staff person.

So what is the alternative? Although knowing what your gross accounts receivable balance is important to you because you would like to try to figure on what money might be expected, this is not a report to use to bring more money into the practice. Instead, every good billing software program should be able to produce what i term your “outstanding claims” and your “guarantor balances”.

A review of outstanding claims every month (and i mean every month) will yield results before claims get too old and the insurance company issues that dreaded code: ‘timely filing denial’. A sharp billing person should not look at this report as foreign because many of the claims on this report have probably already resulted in a denial/problem which your staff should be working on. That is what leads to hopefully a pending file that is reviewed every month. Your staff does not have to look at outstanding claims that were transmitted in the previous 30-45 days as you must give claims a chance to be processed, but surely if you look at the report from 45 days ago and prior, every month, you will get a much better handle on your accounts receivable and your staff will have a tool to review claims that should have paid. Sometimes just resubmitting claims works because the claim did not reach the insurance company. That again speaks to the issue of timely filing, which is why i can’t say enough about making your outstanding claims report your friend.

On the other side of A/R management of course is patient balance bills. If there is a balance on the guarantor report, there should be a patient bill produced each month to match each line item. I urge your staff to know what they are sending to the patient; if the billing person cannot explain the reason for a balance bill, don’t expect to be paid. So the word clean applies here too (see article “cleaning up your claims for better results”) the cleaner the patient bill, the more notes in the computer to remind the staff of why there is a balance (deductible/co-pay/cost share/ not covered/ termed insurance, and the list goes on), the more chance a patient will at least make a payment plan if not just pay the whole balance at once. When I send out 100 balance bills from one of my billing clients, I expect 100 calls and i take the time to know what is in each balance. And when a patient calls to discuss the bill i make notes about any commitments and comments with date and time noted.

Fran Glucroft
Medical Office Manager
Fairfield, CT