Organization the Key to Preserving Your Medical Practice's Bottom Line

In this crazy, sometimes upside down world of medical billing and collection, your only hope for survival is to get and stay organized. While there is no one cookie-cutter organizational system that will work for every office, I do have some tips that have saved my bottom line more than once in the course of 20 years.

The number one way to get and stay organized is to set up a system of reminder files. This can be electronic or paper, depending on your comfort level. The gist of it is a way to easily see what you’ve started and when it needs to be completed. I use reminder files for everything from pre-cert requests I have sent to refunds that have been requested.

My reminder files vary depending on the task. For my pre-cert requests and refund requests, I created an Excel spreadsheet. I list the patient, what was requested, and when I requested it. I also have a column for status notes and a column to list the date I receive the answer. It is an extra step in the beginning, but will quickly become second nature. The time and headache these spreadsheets save in trying to track down what’s going on with a particular request is worth more to me than the small amount of extra work it was to create the sheet and enter the data.

Another type of reminder file I have utilized for many years is a set of alphabetically labeled file folders in one drawer. Once a month I print the accounts receivable report for any outstanding insurance claims. As I work this report or when I receive an EOB which needs to be appealed, I keep a copy of my appeal filed by the patient’s name in this reminder file. Every two weeks I check through this file to check the status of my appeals. This works perfectly because I have everything at my fingertips to check the status. And God forbid, if the insurance representative says there is no appeal on file, I have my copy and fax confirmation right there to prove them wrong. As I am checking the status, I make notes of date, time, and person to whom I am speaking on the cover page of my appeal copy. So when the insurance rep tells me they have no record of this, I can rattle off the list of people who did speak to me about it previously. I can not tell you how many times having these copies readily available have made the difference in claims getting paid.

One of my favorite reminder files is included in our practice management software. This function has various names in various systems, but the functionality is much the same. In my current system, each patient account has a tab called "follow up." You can enter a note here of whatever task needs to be done or has been started on that patient. It allows you to pick a follow-up date and dates to be reminded. When I log into our system, whatever is on my follow-up list for that day automatically pops up. There are options to choose how many times a day you want to be reminded automatically. This is an awesome reminder for those who, like me, get started on one task only to be called away for a hundred other things and by the time you get back around to the original thing, you’ve forgotten where you were.

To prove that my organization system works, let me give you this recent example. I was dealing with three unpaid claims from a major national insurance company whose name is four letters. The problems centered around the fact that ABCD insurance refused to pay bilateral claims correctly. I had called, sent written appeals, sent operative reports, sent copies of our contract showing their own written policy on payment of bilateral procedures, and I had even sent photographs proving that bilateral procedures had been performed. I recorded each appeal and each negative response I received as well as from whom I received it.

At the end of my patience, I made a last ditch effort to contact our provider relations representative, even though the newly published appeals policy by ABCD insurance strictly forbid contacting the provider relations reps for claim issues. I sent an impassioned plea to her detailing my frustrating history with these three claims. She called me immediately to discuss these issues in further detail. She said she might be able to help if I could provide her with exact details of to whom I had spoken and exactly when. She sounded a bit too confident in her emphasis on the word  if , as if she knew I would never be able to produce enough detail to warrant her getting involved. She had no idea who she was dealing with because I pride myself on being the "Queen of Details." I emailed her the summary of dates, times, names, and responses from my reminder files.

A week later, I received a call back from her saying that all three claim denials were overturned. We have received the first of the three payments. The other two should be here this week. We were even paid interest because I was able to prove that a clean claim had been received yet not paid correctly in the timeframe allowed by the State of Georgia.