The past decade has seen significant changes throughout the United States’ healthcare delivery system. Among them is a substantial rise in outpatient services centers, many of them imaging centers. According to reports by market research firm Verispan (Yardley, Pa), freestanding diagnostic imaging centers have grown in excess of 10% per year during the past 3 years, creating more than 5,500 outpatient diagnostic imaging centers nationwide. It is anticipated that by year’s end, this number will reach 6,000. With increased competition, it is imperative that providers manage their businesses effectively and, from the outset, pay close attention to their most valuable assets.

Accounts receivable (A/R) is one of a center’s most valuable assets, and it’s important to carefully protect, value, and manage it. Clinics can follow several effective guidelines to help manage their A/R process and achieve better-performing practices. Which guidelines have the biggest effect and why is different for each practice, but a few common denominators should not be ignored.

Many experts and consultants focus on how businesses should manage A/R after items are recorded. What most centers and clinics fail to recognize, however, is that effective A/R management actually begins before the patient enters the center for services. Often, once A/R is booked, the ability to turn it into cash could already be lost. This attention to detail should begin when the patient appointment is set or, at the very least, by the first encounter.

Implementing a centralized scheduling function in a large clinic provides scheduling personnel with adequate time to capture relevant data accurately. It also allows for confirmation of patient insurance information and verification of eligibility. However, the lack of centralized scheduling functions in smaller centers should not prevent operators from implementing appropriate policies to ensure reimbursement. Appropriate training of reception personnel in such a practice is critical to the process. Some centers use the Internet to access sites dedicated to benefits verification, eligibility, and preauthorization, all of which can help eliminate potential costly errors.

Communicating with patients at the time of service about financial guidelines, policies, and procedures will help increase patient satisfaction. Many physicians and staff are uncomfortable having financial discussions with patients, especially during a visit. Rather, they are focused on patient care and meeting the needs of the referring physician, and they often postpone the financial discussion until after services are rendered. Depending on the patient’s insurance coverage, that could be too late. Most patients expect their financial responsibilities to be clearly communicated in advance. To ensure high patient satisfaction and an optimal patient experience, developing and communicating clear guidelines on payment expectations, verifying benefits, and obtaining referrals and preauthorizations is paramount. This might seem overwhelming, considering the patient has yet to be seen; but in the long run, satisfied patients usually lead to a positive bottom line.

Another important component to a successful A/R strategy is to educate all employees about the importance of billing and collections. It is not necessary to hire high-priced consultants or trainers. Instead, the best resources can be found right in the clinic. For example, by arranging regular training sessions that focus on a cumbersome aspect of billing or coding, an operator can demonstrate best practices on-site. Keeping it short and simple, such as starting with one or two subjects, will best hold employee interest.

Most insurance carriers employ provider relations representatives. Take advantage of this resource. These individuals are trained to visit offices and talk to both physicians and staff about specific issues, such as precertification processes, referral coordination, or the entire claims-adjudication process. They can provide manuals that identify different types of cards that patients might carry, or they can share a list of contacts in the company by department to help facilitate problem-solving.

Once the patient has received service and their results have been distributed to referring physicians, certain steps must be implemented for smooth and rapid collection.

1) Establish processes for appropriate coding, billing, and collecting. It is fortuitous to define specific procedures for monitoring each step in the collection process. The steps, albeit complicated at times, can occur within hours of a visit. Each missed step presents an opportunity for a claim to go astray, perhaps resulting in lost revenue or healthy A/R that might turn into bad debt. Internal “days” are critical to cash flow to ensure that no revenue slips through the cracks. Some critical questions to consider include:

  • How much time passes between a patient’s visit and the assignment of a procedure and diagnostic code?
  • When are codes entered into the practice-management system?
  • What is the time span between posting the encounter into a practice-management system and actually submitting the claim?

2) Assigning procedure and diagnostic codes is critical to every medical practice, and imaging centers are no exception. It is best to use coding experts certified by the American Academy of Professional Coders (AAPC of Salt Lake City) to warrant accuracy. This step not only affects a center’s cash flow but also helps avoid costly audits or claims related to fraud and abuse. These initiatives also can help avoid possible Medicare sanctions that can detrimentally affect any healthcare practice.

3) Whether a center uses in-house resources or contracts with an outside billing service, the billing professionals hired should possess specific experience relevant to the local market. Markets vary across the country and are not standardized. Therefore, rules for claims submission, acceptable codes, and state regulations regarding form submissions span the spectrum. Hiring an employee or an outside service with local market expertise and experience in the relevant specialty will foster effective collections, and, ultimately, positive A/R.

Setting concise, measurable goals and continually publishing them for the entire staff to review can prove invaluable in any medical practice. The Medical Group Management Association (MGMA of Englewood, Colo) has identified certain benchmarks for successful A/R management, which are updated annually. It is important to educate staff about these benchmarks and expectations.

Sans any previous establishment of A/R performance benchmarks, a center should begin by analyzing its A/R percent and collection ratios over 120 days. Setting specific objectives toward achieving even the smallest of improvements can have a significant impact. It also is beneficial to continue monitoring A/R performance once goals are met or exceeded. Chart the progress made toward achieving the center’s goals, and establish small rewards as they are reached.

Ginger A. Ryder is president of National Medical Management (NMM of Bellevue, Wash).

Antony G. Clarke is co-founder, president, and CEO of Renaissance Medical Ventures LLC (Bellevue, Wash) and a member of the Medical Imaging Editorial Advisory Board.