Five Tips for Improving Radiology A/R Management

The problem of a growing percentage of revenue being tied up in A/R is common to many practices says Carrie Moneymaker, operations manager for Zotec Partners, the leader in radiology revenue cycle and practice management.

“Practices love to look at their payor mix and say‘I have 25 percent Blue Cross/Blue Shield, 20 percent Medicare and my commercial is this or that — I’m so healthy.’ Then you look at the A/R and they have 35 percent of their A/R as aged patient responsibility,” she says.

The reality is that patients, are now the number one payor and this has a big impact on A/R management. 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 put more effort into managing their A/R to ensure a healthy cash flow.

So what can be done? Moneymaker has five tips:

  1. Actively engage the patient in the payment process early on and make paying the patient portion as easy as possible.“It is a little bit taboo to go out there and ask patients for this money, but you have to collect it as soon as you can in the revenue cycle,” Moneymaker says. She adds that practices should ideally have a consumer-driven workflow focused on obtaining payment from the patient that recognizes that different patients have different payment behaviors. Zotec uses data on patient payment behavior over time to help front desk staff know which patients promptly pay bills sent to them after service and which ones should be asked for their portion of the payment at the time of service.
  2. Make sure claims going out are as clean as possible. Zotec works directly with almost all the carriers in the claims submission process which allows it to have a very robust front end rules engine to ensure all needed information is there before the claim goes out.“That mitigates the possibility a claim is going to come back denied and because we are going direct to the carrier, we have a cleaner handshake with them,” Moneymaker says.
  3. Have established timelines for follow up. Zotec has eliminated paper follow up for most claims and instead automates claims tracking, so that if a claim sent to a carrier doesn’t come through when expected, Zotec can follow up right away to make sure the claim was received and there isn’t a problem.“We are not waiting 20, 30, 45 or more days to ask,‘Where is the Blue Cross adjudication or message back on that claim?’ We are reaching out to them very quickly to say‘Hey, where is the feedback on that claim?” Moneymaker says.
  4. Avoid rework. When claims go out clean and organized, there is less work when they come back.“The cleaner the claims go out, the cleaner they come back and that means that there is less work for your team to figure out what is going on when the claim comes back,” Moneymaker says.
  5. Employ a data-driven hold on claims where the patient portion needs to be collected first before the rest of the claim can be submitted to the carrier. Zotec 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 the deductible 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,” Moneymaker says.