There's Nothing Professional
About Not Getting Paid

by Jason Blakeley

This election year has brought about serious debates regarding our current health care system, and reform is the obvious choice for both major parties. However, almost no one in this country expects to see “socialized medicine” here any time soon.

So, of course, physicians in private practice will still need to bill and collect for the medical services they provide, like any other professional. Obtaining proper reimbursement for the services you provide is mandatory, although many physicians and billing companies struggle to accomplish this goal, and often fall short. By the way, the definition of professional includes meaning that you get paid for what you do.

Many insurance carriers have become very sophisticated and have made the claim submission and reimbursement process more challenging than ever. These firms have put technology and internal systems in place than can be obstacles to prompt and proper reimbursement. For example, the sophisticated systems they use often result in claims being edited or denied for administrative or technical reasons. It’s easy for practices to lose sight of some of these claims unless they have effective systems of their own in place to manage and track them. The real trick, is actively receiving timely payment for services you provide from all sources. This includes payers you participate with and others that present even more difficulty such as the underinsured, insured by questionable payers, some PPOs, and managed care plans that you don’t participate with.

It literally pays to have experts do your billing. These are people who, like you, are professionals in their field. They spend the majority of their workdays in the billing arena, and consequently stay connected and aware of new guidelines and regulations. If these guidelines, regulations, and rules are overlooked, then the usual result is denied, unpaid claims. Whether you outsource your billing, or do it in-house with your own billing staff, it pays to have professionals at the wheel, steering the way.

Your billing resource starts with well-designed financial policy. This policy is shared with all members of the staff and includes a list of those insurance companies and government programs you have decided to participate with. It spells out concisely what you expect from patients regarding co-pays and annual deductibles. This financial policy informs everyone of what their payment options are (check, credit card, payment plan), and when a referral from another physician is required.

Because self-pay receivables have become a growing concern for many of you, you should be looking to manage these accounts with increased efficiency. For this reason, the financial policy should be shared with patients. It should be on your web site if you have one. It should be included in your patient information brochure and as a separate handout to include in statements and handed to patients in the office when they are asking questions about their bill. With the painfully obvious shift of financial responsibility from employer to patient, it’s only fair to make the rules known—it’s in everyone’s best interest. New patients will pay more promptly and have fewer questions if they are informed, before their first visit, of your financial expectations.

After all, part of being a professional is being better than the amateurs, and professional financial awareness leads unswervingly towards more money.

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