The father of the Total Quality Movement, W. Edwards Deming said, “You can expect what you inspect.” He believed that inputs plus process equal outputs. In visiting our member’s practices we have discovered that several offices are carrying balances longer than they should be and in some cases even writing off balances because they are past a filing date for a third party plan! We encourage each TSO Network office to inspect the inputs and process within the billing department so that we can get the results we expect. This will create an assurance that these crucial cash flow elements of our business are being handled correctly and that our staff have an opportunity to brag about how truly fantastic they are! We recommend a weekly ten minute meeting in which the billing specialist has already pulled a couple reports for the operations leader to review and ask a couple follow up questions. The following is a guideline that Cindy Huynh and I compiled to serve as a guide to direct your ten-minute weekly meeting:
REPORTS FOR BILLING SPECIALIST TO PULL:
Patient Cash Balances: Aging report with total of all outstanding balances past 45 days and top offenders to be targeted this week with follow up contact (If any exist).
Audit Summary: Your billing specialist should provide five audits (minimum) to the operations manager that demonstrates what the patient and insurance should have paid, as well as how much should have been written off.
These should all be conducted for the same insurance and should cover a variety of cases; (not all exam, frame, and single vision poly lenses) this variety will ensure that you aren’t letting reimbursement slip through the cracks in certain circumstances. In the event that the reimbursement is wrong, audit more cases with the same circumstances and find the cause of the error. Then train to prevent it from happening again.
Breakdown of Patient Mix: Monthly summary report that indicates what portion of your patients are on which insurance plans can provide to be helpful in understanding the needs of your patient base.
Vision Insurance Balances: Aging report 45 days past due balances with total of all outstanding balances and a breakdown by vision insurance company.
Medical Insurance Balances: Aging report 60 days past due medical insurances with a breakdown by medical insurance company.
If you need some additional assistance with your billing specialist/department, please contact your area’s Market Manager or reach out directly to Cindy Huynh, TSO Operations Manager at 713-953-7600 x 203.