3 Ways to Reduce Payment Delays

Main Points

Set up Electronic Funds Transfer with your insurance companies to make sure that you are getting payments directly
Complete Eligibility and Benefits checks so you know what the patient owes and what the insurance company owes
Know your Credentialing status with each insurance company so you can submit claims seamlessly

Cash flow is King... Or so they say in private practice. It is important to maintain a healthy cash flow especially when starting a practice. But if you have a well-established practice knowing that you have cash flow is especially important particularly if you have staff.

The problem is that if you are taking insurance, you are relying on another company for your cash flow. This can be problematic knowing how unstable insurance can be. Insurance companies, historically, have been held to a 30-day payment requirement based on legislation that was passed in the 80s. However insurance companies have found ways around that and can delay payments for various and sundry reasons.

Therefore, it is up to you to make sure that your payments and your cash flow is coming in regularly. There are three main ways to ensure that the payment from insurance are steady and consistent.

Set up Electronic Funds Transfer with your insurance companies to make sure that you are getting payments directly. The first way to ensure that you don't have any undue payment delays is to set up electronic fund transfers or EFT with your insurances. This means that you were cutting out the middleman of the mail system. Historically, the mail system has been very good but if the insurance company has your address wrong where you move locations those payments will get lost in the mail. When you set up EFT you insure the payments will come directly to your bank account and with some payers you can specify whether you want payments daily, weekly, or monthly.

EFT also allows you to track all your payments so that you know exactly when you're getting paid. This process usually coincides with the electronic remittance advice process so you can post payments directly into your practice management software. This allows for greater accountability among your administrative staff or when posting payments because electronic remittance advice's are produced by the insurance company directly and are usually pushed to the practice management software in conjunction with the payments.

By setting up EFT and electronic remittance advice you can ensure that your payments are timely, accurate, and efficient. One downside of setting up EFT is that if the insurance company needs to recover any money they tend to take it directly out of your bank account. Sometimes insurance companies will reduce payments instead of taking out of your bank. You will want to make sure there is some money left in your bank account in case this happens.

The other way of ensuring that your payments are not delayed is by doing eligibility and benefits checks regularly. Complete Eligibility and Benefits checks so you know what the patient owes and what the insurance company owes. This helps with timely payment in two different ways. The first way is that you know exactly what the patient should know. The closer you can get payment from the patient to the session the better. It is unlikely that you will receive payment for sessions after the patient has left your office.

The other way that doing eligibility benefit checks helps with timely payment is that you should know what the insurance company will pay you or what their cost share of the session is. By knowing what is covered, what sessions need authorization, and the patient's cost-share, you can estimate the risk of a patient and the risk of getting paid by the insurance.

You will want to look out for any carved-out insurance plans or any plans that you are not in network with. This takes us to our last way of ensuring timely payment.

Know your Credentialing status with each insurance company so you can submit claims seamlessly. Knowing how you and your clinicians are credentialed is critical to the success of your practice. If you do not know how you or your clinicians are credentialed then you will run into payment issues along the way and when dealing with insurance. Some key factors to know in relation to your credentialing are which address you are credentialed with, what NPI you are credentialed with, what tax ID you are credentialed with, what insurance plans you are in network with, and who your network management representative is from each insurance company.

That last reason is very important because that person can operate as a point of contact or an intermediary between you and the insurance company. They can often act as an advocate for your practice and increase the velocity of payment or the resolution of issues to your practice.

The other way knowing your credentialing helps a timely payment is by confirming information to your biller so that claims do not get denied. If your biller or administrative staff do not know how you are credentialed then you may experience payment delays or claim denials which will take more time to resolve thus slowing your cash flow.

By looking at these various tips of managing your practice you can guarantee or at least have a better shot at timely payment from both the insurance company and from the patient. If you're finding that you were consistently running into issues with the insurance company or with your patients then you can give us a call at 734-437-9432 or contact us via the website and we would be happy to talk with you about different solutions for your practice.