Use Your QAP to Collection Success

April 27, 2012 by  Filed under: Management 

Medical practices may want to look hard within their own businesses to see where there is cash leakage. Specifically, are you collecting all that you are entitled to?

How do you even know?

There is one sure way to find out. That is by making sure you have an intense, monitored, unflinching quality assurance program (QAP) in place.

In fact, this could be the most critical element to your practice when it comes to collecting revenues. It forces all of the staff to respond to an authority higher than themselves. The QAP provides an invaluable, non-judgmental report that can be used as a guidepost to improvement, more collections and even as procedural reviews that can make your practice more efficient.

Some points to explore in a QAP include:

Guarantee all services are billed monthly. While this may seem too basic. It is not. Each day’s services should be generated on a booked and provided report. Next, generate a report of all services not billed due to a cancellation or other reason. This will increase billing because many facilities miss claim submission opportunities. Examples include a service that was just “squeezed in” or a missed treatment note.

Review cancellation reasons. If cancellations are the result of too long of a wait, it may be time to adjust your business hours or add staff. If certain staff members have a higher rate of cancellations than others, it may be time to review their customer service skills.

Examine your coding and reimbursement process. Find out if all the codes are accounted for and each line item paid for. See if the bills and provider claims have been submitted on time. It may also be wise to have two coders check each code to ensure accuracy.

Check reimbursements. Make sure you have looked to see if payment has been received in a timely manner. If not, examine if the items are being followed up on and pushed for payment.

Review zero pays. Zero pays are important to review because they could be the result of incorrect coding or insufficient documentation. They could even be because of inappropriate insurance denials.

Overall, these five points, if reviewed properly in a QAP, can help your medical practice collect more money, tighten up procedures and uncover ways to improve the business end of your practice. It is definitely worth the time to expend effort into creating a good QAP that is relevant for all of your staff.

McLaughlin founded RMK ( ) in 1980. With two employees and a few small accounts, he developed the business that has collected and processed more than $100 million in debt collections since its inception.

The business focuses on medical billing, revenue management, accounts receivable management, collections, subrogation, revenue enhancement reviews, and billing office-staffing analysis in addition to its full collection agency service programs. RMK clients include major hospitals, medical clinics and providers from all over the US.

Contact Ronald McLaughlin for more information about RMK’s medical billing, coding and revenue management services.

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