Five Steps to Prepare Your Practice for the Coming Year

For physician office managers and patient billing specialists, now is the time to prepare for 2017. Every calendar year brings changes to accounts receivables and cash flow as patients change plans and restart deductibles. As government payments are increasingly tied to quality, it will also be important that providers capture complete clinical information about visits.

Read on as TriZetto Provider Solutions® industry affairs professionals share five things you can do now to prepare for the new year.

  1. Set up eligibility verification: One in five commercially insured patients will change health plans next year*. While billing specialists verbally ask patients about plan changes, patients often don’t remember, leading billing specialists to submit claims to the wrong plan. This leads to denials, which impact accounts receivable, cash flow and workload. To prepare for the coming year, you can introduce eligibility verification technology into your practice. This is a foolproof way to determine coverage. To reap the full benefit, experts recommend you use it on every patient, year-round.

  1. Plan to communicate about, and collect, patient deductibles and co-pays: When the new year starts, deductibles also sunrise. In 2016, four out of five patients with employer-sponsored individual coverage had a deductible, averaging $1,478. Average family deductibles ranged from $2,245 to $4,343, depending on the plan type. If history is any guide, the widespread use of and dollar limit on annual deductibles will continue to grow .

    Deductibles impact your cash flow, because in the new year, a much higher percentage of payments come from patients. While health plans pay in 30 days, patients typically pay in 75 days. In response to a growing amount of revenue coming from patients, some practice managers choose to request partial or full payment up front. An electronic patient estimation tool, which calculates in real-time the patient’s financial obligation for services, can help. Some practices are also providing options to patients with financial hardships, such as payment plans.

  2. Improve documentation: The new Medicare payment system, the Merit-Based Incentive Program or MIPS, will impact Medicare payments for care delivered in 2017. To optimize reimbursement, your providers will need to demonstrate that they have improved quality, value, efficiency and the use of electronic health records. Now is the time to remind providers that to succeed under MIPs, they must strive to completely and accurately document patient visits and care delivered.

  1. Clean up files and codes: With high staff turnover in the billing office of many physician practices, contracts and network agreements are sometimes misplaced. Now is the time to find and file every payer contract and network agreement.

  1. Review and update your chargemaster: The new year brings new contracted fee schedule rates, so to prevent undercharging and leakage, it is important to have the most up-to-date rates in your system. For example, if you are contracted with a payer for a procedure at $500, but your chargemaster is set to $425, you are costing your practice revenue.

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