Clear Policies: Be proactive against shrinking reimbursements

Key Points

San Francisco-Every positive step one can take to improve reimbursements is worthwhile because a series of small gains can add up to a lot. Several eye-care administrators offered hints on how to take those steps at the annual meeting of the American Society of Ophthalmic Administrators here earlier this year.

Front desk collections

Jolynn Cook, RN, COE, administrator at Laurel Eye Clinic, which has 10 offices and two ambulatory surgery centers in Northwest and Central Pennsylvania, said her group has focused on improving front desk collections to avoid the overhead of collecting those fees later.

"Our new policy is that unless the visit is [an] emergent situation, all monies are to be collected when the patient checked in," Cook said. "We decided that if the patient was not prepared to pay, the visit would be rescheduled. We have encountered little resistance to this."

Before implementing this policy, a special staff training session was held.

"We developed scripts to help them get over their reluctance to ask patients to pay," she added.

She now receives a weekly spreadsheet that shows how much is actually being collected at check in. When all 10 offices hit 100% of collections, staffers are rewarded with extra paid time off, up to 4 hours a month. Previously, the front desk collection rate was 40 to 45%; now it is closer to 98%.

"This has been an incredible jump-about $20,000 more per week," Cook said.

Other steps her group has taken include a hiring and wage freeze and reduced pension contributions. Also, they monitor employees' time more carefully. If physicians are out of town and there is not much work to be done, techs are scheduled for fewer hours.

"I find the best way to do all this is to be as honest with the employees as possible," Cook said. "Give them a lot of feedback, and always be as transparent as possible."

Accounts receivable management

Sandra Regenye, billing manager at Horizon Eye Care in southern New Jersey, stressed the importance of accurate patient information. Get patients' names exactly as they appear on their insurance information, and be sure to have their actual addresses, not just mailing addresses.

"It helps with identifying the nearest office for them to use and can be useful if you have to take them to small claims court later," she said.

Get alternate contact information to use in case of emergencies, as well as employer information. "You may have exclusive contracts with their employer[s], and knowing who they are helps you honor them," she said.

Having patients sign financial agreements is important too, she said, because it informs them up front that if they did not obtain a referral or bring a co-pay as applicable, then their appointments will be rescheduled, and if they do not show up for an appointment, then they will be charged.

"Show them the respect that they show you by educating them fully," she said.

Physicians need to know what services are not covered by insurance and be part of the process of educating patients so no surprises occur later.

"The days of being exclusively a provider are long gone," Regenye said.

She said that when claims are rejected, send the patient a bill right away. This act will get them engaged in the appeal process much faster than calling them.

She offered these final tips:

"There is no silver bullet to what we do," she said. "AR management is exactly that. Find the things that work for you."