Five Tips for Improving Emergency Medicine's Accounts Receivable Management

The challenge of managing the Accounts Receivable is common to every practice says John Holstein, Director of Development for Zotec Partners, a leading national provider of emergency medicine revenue cycle and practice management.

“Practices too many times focus on their payer mix and conclude ‘I have 25 percent Blue Cross/Blue Shield, 20 percent Medicare and my commercial is this or that, so my practice is healthy." Then you look at the receivable and they have 35 percent of it as aged patient responsibility,” he says.

The self-pay patient has always been a challenge for emergency medicine. Today's reality is that patients have become an extremely critical segment of every practice's receivable. Based on recent Kaiser Family Foundation research, average deductibles for covered workers have risen 12 percent, to $1,478 since last year. This means that practices need to focus considerable effort on the self-pay financial category of their payer mix, as these patients can impact virtually every other category, except traditional Medicaid, however, even that may change in the not too distant future. This is also very critical to managing cash flow.

So what can be done? Holstein notes five tips:

  1. Ensure the emergency department registration staff is fully trained to capture accurate, complete and current patient insurance information. It is absolutely critical that "current" coverage information is obtained. We live in a very fluid and volatile healthcare environment, and this will very likely continue changing at a very rapid pace. Additionally the level of patient confusion about their coverage very likely stands to increase possibly dramatically, making the task of registrars collecting correct information even more critical today and their work a vital part of your success.
  2. Ensure claims being submitted to payers are absolutely clean. A market differentiator of Zotec Partners is we submit claims directly to all payers who accept electronic submissions, using a very robust front end rules engine to ensure all needed information is included on claims before the claims are submitted. “This mitigates the possibility of claims coming back denied and importantly insures we have a cleaner handshake with payers,” Holstein says. Cleaner claims submitted directly to payers, not clearinghouses, results in smoother cash flow as well.
  3. Thoroughly know and execute on established payer timelines for follow up. Zotec Partners has built an exhaustive knowledge base of payer payment policies and protocols, enabling us to immediately identify when a payer(s) has missed their expected timeline for your payment. We follow up immediately, questioning the delay in a payer's response. “We are not waiting 20, 30, 45 or more days to determine the status of any given claim.
  4. Avoid rework. When claims go out cleanly and organized, the back-end process is much cleaner when the payer's response is received back. “The cleaner the claims go out, the cleaner they come back which means the entire receivable adjudication process runs so much smoother" Holstein adds.
  5. Employ a data-driven and well thought out hold on claims process when the patient's responsibility of the claim needs to be collected first before the payer's responsibility kicks into the process. Zotec Partners uses an advanced tool called ZITCH, which stands for Zotec Intelligently-Timed Claim Holds, to identify the individual medical encounter and hold claims long enough for patient deductibles to be paid and processed. “Practices sometimes will hold claims for a period of time during January or February because of high deductibles, but with deductibles today taking the patient the entire year to pay, now you cannot just say the first months of the year are the months for high deductibles. It can last through the entire year,” Holstein says.

Bottom Line: Managing today's accounts receivable requires smart people executing protocols with state-of-the-art technology.