I’ve listed a few reasons below as to why doctors might be struggling with their billing and/or practice management.

1. Not Checking Eligibility and Benefits Prior to the Patient Visit a. Let’s the practice know if authorization is required b. Let’s the practice know if patient has deductible, coinsurance and copay

2. Not Acquiring Authorization When Required Before Service is Rendered to the Patient a. If authorization is not obtained prior to the patient being seen, the claim will not get paid b. Authorization must be under correct provider NPI, authorization date range must include date of service, and the CPT code the provider is wanting to bill.

You’d be surprised how many mistakes happen here!

3. Time Management of Their Billing Staff a. 1 person trying to handle the billing as well as other administrative tasks. This just doesn’t work well for a busy practice.  b. Submitting claims in a timely manner is imperative to quick reimbursement c. Following up on claims in a timely manner is imperative so you know if there are any issues.  d. Timely filing and follow up on claims is imperative to maximize cash flow. e. Resubmitting claims within timely filing limits regulated by insurance companies f. Sending out patient statements timely and frequently

4. Properly Recording Payments and Managing Their A/R Effectively a. You’d be surprised at how many providers or their staff do not enter the payments into their billing system.  b. This is necessary to keep track of a real financial snap shot of the practice as well as managing the patient balances

5. They are Paying Too Much a. Providers need to know they have choices. Ask them if they’re paying for software or a clearinghouse b. As a practice management professional, it’s important to evaluate all their processes related to the billing so see if they can be improved or cost reduced. This includes credit card processing and EFT services as well.

Remember, you’re going to be dedicated to their account, follow up and submit in a timely manner, do light accounting for them by posting payments and sending statements, give them real-time snap shot of their financial standing at any point in time, be in communication with them when they need to speak to you and are always looking for ways to improve processes and increase cash flow in the practice.


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Suite 4533
Scottsdale, AZ 85258

Phone: 1 (888) 311-8022
Fax: (602) 585 - 9558

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