Claims Management

How does your practice handle claims management? Just keying in the data is not enough. You must have a system to keep up with what you are doing. No two practices are alike and not all have the same level of expertise. For this exercise, I will follow two parallel courses, one on the lower end of technology and one on the upper end. Every practice will be different and may want to modify either procedure.For the lower end, what happens once a patient walks in the door? Do they sign on the sign in form or not. I have seen some practices that do not force each patient to sign in. They think it is confusing trying to keep up with what patients are here just for labs and which ones are here for an office visit. If this is your practice, let’s look at another possibility.Take a few spiral bound notebooks. Label one for each of the services you think you need; perhaps one for office visits and another for labs. Make sure each page is dated with the appropriate date. Before a patient has an encounter form filled out for either service, write that patient’s name in the appropriate notebook.At the end of the day, rectify the names in the book with the encounter forms. Make sure you have an encounter form for each and every patient. It is really sad to see a provider work so hard and then have claims that are not filed because no one bothered to set up a system to verify that each and every patient was being tracked. If the patient has a no charge for the day, still create an encounter form and write the appropriate information on it; no charge, not seen, whatever is appropriate.For those on the upper end of the technological line, use the appointment scheduler in the billing software. Even if you farm out your billing to a qualified service, you should be able to use their software to create all of your appointments. If you, like the practice above, want to utilize more than one tracking mechanism, utilize two or more resources in the appointment scheduler; label one Doctor Feelbettersoon and the other labs, allergy injections, or whatever else you use. Print all of your encounter forms from that scheduler. If a patient walks in that is not on the schedule, place them on the schedule and then print that form. You can have the scheduler print the entire fee ticket or you can use preprinted tickets and merge them with the scheduler. No patient is permitted to go back unless there is a fee ticket printed for him. While you are at it, enable the number sequencing part of the fee ticket printer. That will create a unique number for each and every ticket and will help you know if all of the tickets have been accounted for at the end of the day. In addition, cross reference the tickets to the scheduler and make sure you have all of the tickets for the day.In both of the cases above, once the data has been entered into the practice management software, verify that what came in through the system above is going out as a claim. Your medical billing staff should run a day sheet at the end of each day to both verify the patients for the day and to lock the data to keep someone from accidentally or intentionally changing it. I hope you find this useful and if not, please let me know how it might be improved.