END-OF-THE-YEAR CHECKLIST FOR MEDICAL OFFICES

Here’s what you need to do for your medical office before the end of the year.

2. Make Sure All Claims are Submitted

There’s a saying that goes: “If you’re early, you’re on time. If you’re on time, you’re late.” A common misconception in healthcare is that claim submissions are untimely and can be submitted at any time.  It is a good rule-of-thumb to develop a consistent workflow that will allow for daily or weekly claim filing and submissions.  At the end of the year, it is good to try to submit all outstanding claims to avoid timely filing, denial deadlines, or troublesome appeals. Insurances typically have all hands-on deck and the priority is shifted during the enrollment period, so the claims are managed more relaxed than usual.  If you find you’re having trouble submitting your claims on time, reach out to us for a free timely filling workflow sheet. Our timely filing sheet lists all major insurances timely filing deadlines.

3. Prepare for Year-end Recoupments

Happy Holiday’s! This time of year also means: “Recoupment Season”. Insurances slow down with their processing and reprocessing of claims around this time and begin performing their own audits. Insurance recoupment occurs when the insurance company has processed a claim and then take back or recoups the payment when they have determined that those benefits should not have been given.  Almost every medical office and hospital has experienced some type of insurance recoupment at some point and time. We recommend offices perform an in-office audit or follow-up on claim submissions to determine the most common take-backs and keep up to date with the latest regulations. This is important as some insurances can perform recoups as far as 6 years back.

4. Authorizations & Verifying Eligibility

The best way to kick off the new year is to get a jump-start on the enrollment changes. After the new year, you can expect many patients to have different changes to their primary and/or secondary insurances. For the first month or two, practice heavily into getting in the habit of asking every patient (for every visit) for insurance information, recent changes, and getting any additional information on file.  It is extremely important to maintain verification and authorization records in case the insurance arises later to deny your claim for “not medically necessary”. Remember, it is never OK to assume that just because a patient comes in on Monday with BCBS, that they will return on Friday with BCBS. A patient can experience a change in their coverage/policy at any time for various reasons. Check all the time, every time.

5. Perform Write-offs

Let’s face it, no one likes taking a loss, but unfortunately sometimes things just happen. Write-offs can apply to claims that are denied due to timely filing, inaccurate or incomplete documentation, non-medically necessary services, etc. The good news is there are some cases in which appeals can work if you can provide the insurance with all necessary documentation. The bad news is some claims will fall under the write-off umbrella. The best way to prepare for write-offs is to thoroughly check your billing workflow, ensure that all has been done in attempt to fight a claim before giving up, and re-visit/understand your insurance contract terms each year.

6. Create or Reshape a New Year Workflow

Whether your office is coming off a challenging year that was full of transitions or your office is riding high in the sunset, everyone can benefit from a workflow evaluation. Depending on your office needs, will determine how extensive some changes should be implemented.  You will be amazed at what a simple end-of-the-year team meeting with everyone to reflect and collaborate can do for your office.  You can take this opportunity to share and shape the goals for your office or even bring in a medical consulting specialist/company to help provide some further guidance in your workflow. Utilize this meeting to discuss the difficulties and accomplishments of the year. If you ask us, a Growth Mindset is always better than a Fixed Mindset.

7. Tackle your Patient Collections

With the recent healthcare changes, patient financial responsibility has increased significantly due to higher-deductible policies and larger co-pays.  This does not only put financial strain on the patients, but also your office. Before the year ends, it is a great idea to take a look at your Patient AR to determine the appropriate course of action.
A couple of things to consider:

• Check eligibility before the patient arrives
• Ensure you have a patient responsibility policy in place
• Be sure your front desk collects before the patient leave
• Ensure your patients are notified correctly about their statements. Whether by mail or phone your patient should receive appropriate notice.