Integrated Billing Process (Overview)

Whether you handle your billing in-house or outsource portions of the process to billing agents, we have identified 8 critical tasks that must have a plan and process in order for your business to succeed.

These activities include things like checking eligibility, obtaining prior authorizations, posting payments, etc. In this article, we will highlight the primary parts of an Integrated Billing Process and over the next several months we plan to break these down into detailed articles that you can implement in your office. Unfortunately, a process is only as good as its implementation so I will preface this by saying that no process guarantees 100% success. That said, let’s take a look at the entire process that tracks everything from daily eligibility to appealing that claim from 6 months ago that your insurance company still hasn’t pay for no good reason.

1 – Eligibility: First and foremost, the patient has to be eligible on their insurance coverage. Not only that, some insurances (Medicaid) require you to check eligibility on each date of service. It’s easy to get overwhelmed by this but the good news is there is technology that can help. We’ll do a separate article about this in the future but if you’re curious, check out https://eligipro.com/ for more info. Likewise, if your front office is having trouble with Commercial Insurance eligibility, have them use our “Eligibility Cheat Sheet” on our resource page.

2 – Physician Signature: Once you’ve verified eligibility, you schedule an intake and evaluation. If the patient requires treatment, you’ll write a Plan of Care and send it to the patient’s physician for signature. Sometimes this is easy, other times the process can take a lot of follow-up. Make sure you have a repeatable system that tracks which Evaluations are written/completed, sent to the physician, and returned as signed.

3 – Prior Authorization: With a signed Plan of care and evaluation in hand, you can now request authorization from the insurance company as needed. Again, ensure you have a repeatable system to track outstanding authorization requests and to inform treating therapists when the authorization is approved. Sending a text is not only a HIPAA violation but it’s not repeatable and scalable for a growing practice.

4 – Daily Billing: Bill your claims on a daily basis. Why? Because it’s easier to catch mistakes and you’ll get paid so much faster. During this step, you should check for all signatures and notes to be completed before billing.

5 – Payment Posting: Post your payments and review your remittance advice on the same day they’re received or as quickly as possible thereafter. This practice, combined with daily billing, will help you catch issues and identify patterns quickly and fix them before unpaid claims begin to pile up. It doesn’t take long for unpaid claims to really impact your cash flow, payroll is always coming up quickly.

6 – Patient Collections: Patient Co-pays and Co-insurance amounts should be collected as soon as possible to avoid growing balances. If you know their co-pay amount, try to collect it on the same day as the treatment. Also, make sure you have a policy about your balance threshold. For example, “Our practice will not treat patients with an outstanding balance over $250.”

7 – Appeals and Corrections: As you review denied claims on a daily basis, try to appeal or correct those claims on the same day to avoid any timely filing limits for these activities. Record your actions so you can refer to it in the future.

8 – Aging Review: Review your Aging Report at least once a month. This is not only important to understand the health of your business but it also helps you identify and check in on claims that you have appeals and or corrected from previous weeks/months.

We will take some time over the next few months and break down each step in the Integrated Billing Process to ensure that your office has a plan and strategy to tackle each step effectively.

Over the years, I’ve worked with many practices to implement an Integrated Billing Process. If done correctly you should expect to see the following results:

• Faster Payments $$

• Faster Patient Care

• Helps Avoid Recoup Requests

• Avoid Timely Filing

• Repeatable/Scalable

• Trackable

• Ensures Compliance

• Auditable

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