TMA’s Reimbursement Services staff work year round with physicians and health plans to help make sure you get paid correctly and on time. They’ve put together a list of practical actions you can take at the start of 2023 to keep your billing and collections on track throughout the year.
- Wrap up accounts receivable. Start off the new year with as many accounts closed as possible. Review what your practice could have done throughout the year to reduce accounts receivable in a more timely manner. Run annual reports of charges, payments, and adjustments. Also run an annual summary of credit balances and aged accounts receivable by date of service. Contact TMA Practice Consulting to get information on how a revenue assessment can help you.
- Pay attention to new plan year changes. Jan. 1 is the start of a new plan year for many health plans. This means not only the start of a new deductible for patients but also a possible change in some patients’ overall benefits or the insurance carrier that covers them. Be sure you have an office policy on how your staff obtain insurance information from patients, verify insurance benefits, and collect deductibles and coinsurance. TMA staff recommend you ask all patients for a copy of their insurance card and that you use payers’ online eligibility verification tools.
- Note changes in Medicare coverage, fee schedule. Jan. 1 is also the start of a new plan year for Medicare. Your Medicare patients may have switched from traditional Medicare to a Medicare Advantage (MA) plan or changed to a different MA plan. It’s a good idea to make sure your Medicare patients are aware of you participation status with Medicare and what plans you accept. Novitas Solutions’ automated phone system at (855) 252-8782 provides MA plan information when verifying eligibility. Also, be sure to follow the correct Medicare fee schedule based on you Medicare participation status.
- Use cost estimators. Use the new year as an opportunity to make some simple administrative changes to improve practice efficiency. Use the cost estimator programs offered by the health plans to collect an accurate amount from your patients at the time of service. The few extra minutes to use them will pay off by reducing the need to bill patients later. They also reduce the amount of time your practice staff need to spend on the phone with insurance companies. Find estimators here:
Aetna Blue Cross and Blue Shield of Texas Cigna Humana UnitedHealthcare
- Sign up for updates. Set up a schedule to review monthly and quarterly announcements from Medicare and health plans. Many health plans send out monthly newsletters, so make sure you’ve signed up to receive an email notification. Because announcements of Medicare changes can overwhelm your inbox, sign up only for notices relevant to physicians.
- Use the new CPT codes. Jan. 1 means new Current Procedural Terminology (CPT) codes. Always use the correct and most recent CPT codes for the services you bill. Check with your specialty society to see what information it has on new CPT codes that may affect your billing. Also check your electronic health record vendor to ensure relevant codes have been added.
- Refresh network links. Within each health plan are many different networks. Use the new year to update your records of all the networks you participate in and make sure all your staff are aware of the networks. Don’t forget to update any postings you may have on your website. Also be aware of your recredentialing status. Recredentialing typically is required every three to five years. Stay on top of your due dates and start early so you don’t miss out on revenue due to network termination.
- Review provider manuals. Remember the new year means new provider manuals from health plans. Review the new manuals, which you can find on the health plan websites. If you are contracted with a health plan, it may make changes within the provider manual that can affect your practice.
- Reevaluate your practice’s financial policies. Maybe this is the year you start collecting all patient cost share at or before you provide services. Consider providing the patient something in writing explaining your charges and the patient responsibility. Don’t forget to remind (or educate) patients that services provided in a hospital setting may, in addition to your service, include those from anesthesiologists, pathologists, radiologists, assistant surgeons, and others. This avoids complaints from patients about the involvement of these other physicians that your staff must take time to handle. This simple step can avoid cost and hassle.
- Review your fee schedules. Obtain updated fee schedules from all the health plans. Compare them with your billing charge to ensure you are not losing revenue due to undercharging. Remember, health plans will pay the lower of your billing charge and the contracted fee.
If you have questions about billing and coding or payer policies, email reimbursementservices[at]texmed[dot]org or call (800) 880-1414, or call the TMA Knowledge Center at (800) 880-7955.
For in-depth help with billing and collections improvement, consider a Revenue Cycle Assessment from TMA Practice Consulting; ask for more information at (800) 523-8776, or email practice[dot]consulting[at]texmed[dot]org. Also, visit the TMA Education Center for courses about collection techniques, and to obtain a copy of TMA’s Policies and Procedures: A Guide for Medical Offices.
Last Updated On
January 06, 2023
Originally Published On
February 14, 2022