Either read this brief Check List before you next billing meeting or take it with your to the meeting.

I.            WHAT ARE YOUR CHARGE AND COLLECTION STATS?

A.                   Request the following reports:

1.      Latest three years of year-end charges and cash collections.

2.      Quarterly charges, cash collections and the collection rates for the most recently completed year and for the end of each quarter of the current year even though it may not be completed.

B.                 The reason you need this data is to spot trends:

1.      Are collection rates getting better, worse or staying the same?

2.      Can you spot certain times when you knew things were affecting the collection activities?

3.      Investigate why fluctuations occurred.

4.      Seek reasonable and accurate answers to variances.

C.                  The key to success is to develop an overall understanding of your charge and collection trends by reviewing quarterly data and spotting problems quickly.

D.                  Develop solutions WITH your administrators and billing team, it is not helpful to point fingers at billing team personnel.

II.                  WHAT CLAIMS ARE CONSISTENTLY BEING DENIED?

A.                   Determine why certain claims are being denied?

B.                   Ask your pro-fee billing team to provide you with a bi-weekly distribution of the Denied Claims Report so that you can identify the claims which are not immediately paid.

C.                  Get this report every two weeks so you can make appropriate corrections so claims can be re-submitted within the acceptable time limits.

III.          HAS YOUR PAYER MIX CHANGED?

A.                   Review your Payer Mix Report at least once every quarter.

B.                   A payer shift from commercial to Medicare of just 5% for an academic proceduralist that generates $1.7 MM in annual charges reduces total collections by $20,000.

C.                  A non-proceduralist faculty member that generates primarily E&M codes and charges of $500,000 can experience a drop in total collections of $9,000 given the same 5% change in payer mix.

D.                  Know the specific payment rules of major payers, including teaching modifiers and other nuances of the companies that pay you for your work.

IV.       ARE YOUR LAG DAYS REASONABLE?

A.                   Lag days are the number of days that it takes for the charge to get into the system once you see the patient or perform the procedure.

B.                   Lag days are an important indicator of "wasted time without payment".

C.                  Delay a note or signing of a chart one week and your collections are delayed a week.

D.                  Ask yourself and your billing team ho your lag days can be improved?

V.           WHAT ARE YOUR ACCOUNTS RECEIVABLE BALANCES?

A.                   Track the accounts receivable (A/R) of your practice.

B.                   Is the balance getting too large relevant to charges generated?

C.                  A spike in A/R during the period could indicate disparate things.

1.        An increase in A/R over a period may indicate more work was performed by you (this of course is an acceptable reason for increasing A/R balances).

2.        An increase in A/R could also indicate that older claims remain unpaid and in the A/R balance (an unacceptable reason for increasing A/R balances).

D.                  The important issue when reviewing A/R is determining the causes of change.

E.                   Be sure to evaluate your own A/R balances -- not the data of the entire division, practice or department.

F.                   Request your own A/R data as part of your regular monthly, quarterly, and annual reporting package.

G.                  Always request a report that identifies all A/R by payer.

H.                   Also request a report that allows you to identify the oldest receivable outstanding -- this allows you to have a conversation with your billing manager as to:

1.        Why the claim is long outstanding?

2.        What is the likelihood of payment?

3.        Should the account be written off so that the billing team can focus on collecting more current accounts?

I.                       Check your "Days in A/R" ratio periodically.

J.                     In simple terms, this number indicates that on average, your collections may take as long as 120 days or as little as 40 days to get cash from a payer.

K.                   Reduce your Days in A/R ratio to the smallest about of time possible.

L.                    A permanent drop in your Days in A/R from 120 days outstanding to 60 days would effectively cause a one time increase of 2 months of additional collections during a 12 month period.

VI.            USE THE INFORMATION HEREIN TO BE CONSTRUCTIVE IN THE APPROACH TO FIX BILLING ISSUES WITH ADMINISTRATORS AND YOUR BILLING TEAM.