32 AE Fall 2011

Analysis—Five Key Areas for Increasing Collections

Running the Practice Revenue

Rosie M. Taulbee, FACMPE

Receipts at the time ofservice can be improvedby implementing basiccollection techniques andpre-appointment screen-

ings. This article describes thesetechniques and screenings and isbased on my experience as a sitemanager in a retina practice.

The SituationIn 2003, I was the new site managerin a specialty office (ophthalmology-retina). It was my role to monitorthe amount of cash, checks, andcredit cards payments accepted inthe site office. Along with the physi-cians and the accounting firm, Ireviewed associated expenses anddecided on methods of improvementor elimination of collections at thetime of service to increase revenues.My analysis was based on five keyareas:• What credit cards were patientsusing and what rate was the bank-ing facility charging the practicefor use?

• Did the site employees haveenough training and patient infor-mation to feel comfortable enoughto relay to the patient the amountof money that was to be paid atthe time of service?

• Were site employees trained andcomfortable in their method ofasking for payment?

• Given that we had three locationslocated in two states, would geo-graphic location be a factor in thecollection process?

By monitoring five areas at yourpractice, you, too, can potentiallyimprove your practice’s collectionsat the time of service.

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• Were systems in place to verifythat there were no improprietiesby employees with respect to han-dling an increased volume ofmoney in the office?

FindingsI began this analysis by reviewingrecords from 2003 and continuedthe process throughout 2010. Here’swhat I learned.

Credit cards. Physicians initiallywere hesitant to accept credit cardssince they were new to the medicalprofession and there was a percent-age charged for usage; yet we hadimplemented them at our site. In2003 we collected $63,528.51 incash, check, and credit cards; $9,956of that was in credit card receipts.Each year upon review of the infor-mation the question arose of how wecould improve this amount.

We decided to implement addi-tional and continuous training ofemployees in processing credit cardsand in how to research copay,deductible, and coinsurance chargesdue prior to the patient’s visit. As aresult, credit card receipts increasedfrom $9,956 in 2003 to $80,247 in2010 (total receipts increased to$168,828.26 in 2010, an increase of266%). The negotiated rates for allcredit cards with the banking institu-tions were based on dollar volumeand varied from 3% to 7%.

We think that the overall prefer-ence for credit card usage (and there-fore the increased receipts comparedto cash and checks) was due to thereward programs offered for card uti-lization and to the economic down-turn in the later years. Patientsfound it convenient to pay their billover time, and some patients indicat-ed credit card payments made it easi-er to track medical expenses for theirincome tax preparation. The annualanalysis revealed that the practicereceived money faster with overnightprocessing of credit cards and avoid-ed dealing with bounced checks.

Training in accessing patientinformation. A key factor in increas-ing our collections was our decisionto conduct pre-appointment researchfor identifying new patients andreviewing their insurance plan. Thepractice utilized a central businessoffice (CBO) employee for thisprocess. This information was loggedin an “alert” format on the patient’sbilling account in the computer andincluded the copay, deductible, andcoinsurance due at the time of serv-ice. This alert could be viewed by thesite employee and relayed to thepatient when the office confirmedthe date and time of the appoint-ment and was restated during thevisit when requesting payment.

Depending on the size of thepractice, the efficiency of theemployee, and the ability to gainknowledge of internal workings ofinsurance carriers’ websites, oneemployee could potentially reviewinformation on 50 to 60 newpatients per day. Obviously, if thisemployee had to telephone each car-rier for information, the verificationsper day would decrease due to waittimes on the phone to talk to aninsurance representative. The fastest,most efficient method involved theemployee logging onto the insurancecarrier’s website, verifying patient eli-gibility, and then reviewing the ben-efit plan for copayments,deductibles, and coinsurance foroffice visits, surgery, and testing forthe current insurance calendar year.

Note that this employee must betrained in the actual plans eachinsurance carrier offers and whetherpreauthorization is required for theparticular physician, the practice’ssurgery facility, testing, or durablemedical equipment, or if the patienthas a deductible or different coinsur-ance for each category. Insurancecards do not always contain this use-ful information.

Training employees in how toask for payment at the time of

service. In addition to trainingemployees how to research patientinsurance plans, we also trainedthem how to ask for the balance dueat the time of service.

There was one issue with puttingthis practice in place: The practicemanagement system had been pro-grammed to print the patient bal-ance and pending amount due frominsurance on the encounter form(this information was based on thedaily “close” that uploaded allcharges, receipts, and write-offs forthe patient’s account). Therefore, itwas possible for incorrect informa-tion to be printed on the form if theupdates were not being performedby the CBO on a timely basis.

We offered three site employeesadvanced training for reviewing apatient’s account by line item billed.(The preferred method of referringthe patient’s questions to the CBOhad been standard practice in orderto allow employees to focus on thepriority of patient care.) After theemployees researched and acquiredinsurance information, entering thatdata in the appointment scheduler,we instructed employees to gathercharts and print encounter forms,then highlight the patient balanceon the encounter form. We recom-mended that patients be reminded oftheir balance due when the officecalled them to confirm theirappointment 2 to 3 days prior to theappointment. Often this resulted incanceled appointments or patientno-shows on the appointment dateand time. So we tracked all no-showsor canceled appointments that werenot rescheduled, and we called thesepatients again, three times. If no visitwas confirmed, the referring physi-cian was notified and a discharge let-ter was sent to the patient (for legalreasons).

We had additional training forsite employees that included role-playing and monthly review to

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34 AE Fall 2011

and benefits. The physicians, manag-er, and accountant discussionsrevealed the expense was justified fortimeliness of payment processes andpatient information, questions, andsatisfaction.

Geographic location. We want-ed to see if geographic location ofthe three practices had any impacton varying the income collected atthe time of service. We documentedthe actual hours worked at each loca-tion, and we verified the potentialamount of copayment, deductible,and coinsurance by comparingpotential receipts to actual receipts.We deduced that the actual locationof the practice site had no bearingon the increase or decrease in collec-tions, as the driving force was thevolume of available hours open forappointment and the internalprocesses for collection.

Audit systems. From 2003 to2010, we increased our receipts atthe time of service and thereforerequired improved internal audit sys-tems to deter improprieties. Our pol-icy was zero tolerance. We auditedcredit card usage daily for voided,returned, and credit transactionsprior to settlement statements. Atthe end of each day the encounterforms were totaled for cash, check,and credit card payments. The actualmoney (in the money box) collected

assure them of their ability to per-form a three-part appointment con-firmation, charges review, and pay-ment request process. The threeparts:

1) Reviewing prior balances foraccuracy.

2) Asking for the current balanceand any prior balance by simply stat-ing the balances and if the paymentwill be check, cash, or credit card.(We also wrote down the reason fornonpayment on the encounter formfor future collection processes andrequired that a copy of theencounter form be handed to thepatient at the end of each visit.)

3) Making a return appointmentor relaying that the patient shouldreturn to the referring physician ifthe patient was based in a specialtypractice.

With this three-part format, thepatient always leaves on an upbeatnote (as opposed to making anappointment then being asked formoney).

The pre-appointment screeningaccelerated the information neededby the site employees to increasereceipts and was a tremendousimprovement. Expenses associatedwith the process were reviewed uti-lizing multiple employees, creditcard machines, deposit slips, trackingof receipts, and employees’ salary

Running the Practice Revenue

was totaled and balanced to the orig-inal documentation on the forms.Duplicate or reprinted formsrequired sign-off by a physician ormanager. A bank deposit slip wascompleted and a different employeeverified the money and took thedeposit to the bank. This way thebank could not state that all of thecash was not deposited because twointernal employees verified theamount prior to the deposit beingtaken to the bank. Also, if patientsreceived a bill, the phone numberwas directed to an employee at theCBO who requested a copy of theencounter form from the manager toverify the charges and payments andreviewed the information with thepatient. The verified bank depositand the credit card settlement formwere returned to the site manager forentry into the attached exhibit fordaily, monthly, or annual statistics.

TakeawayDuring the past 8 years, we continu-ously stressed the importance ofreviewing these five identified areasfor increasing our collections at thetime of service. We continue toimprove internal techniques by pre-screening patient accounts, relayingaccurate patient information to thesite employees collecting money,training these employees on collec-tion techniques, accepting creditcard payments, and implementinginternal audit processes. By monitor-ing the five areas above at your practice, you, too, can potentiallyimprove your practice’s collections atthe time of service. AE

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Rosie M. Taulbee, FACMPE(513-353-9079; taulbeerosie@hotmail.com), is the man-ager of Vitreo-Retinal Surgery,Cleves, Ohio.

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