Scheduling 

  • Does the practice verify insurance info (using batch eligibility) prior to appointments?
  • Are the patients informed of payment expectations prior to arrival for their appointment?

Registration/Check-in 

  • Is the staff trained to collect co-pays, deductibles and past-due balances at check-in?
  • Does the practice have a written financial policy that is provided to all patients?

Coding 

  • Does the practice verify coverage for specific services?
  • Does the practice update procedure and diagnosis codes annually, as well as perform a coding audit?

Charge Capture/Claim Submission 

  • Does the practice capture 100% of office and hospital charges?
  • What is the lag time from date of service to date of claim submission?
  • Are claims submitted daily?

Cash Application 

  • Does the practice use electronic funds transfers (EFTs) and electronic remittance advices (ERAs)?
  • Does the practice load payer allowables and track payment variances?

Denial Processing 

  • Does the practice track denials?
  • Does the practice monitor write-offs and have an appeals process?

Accounts Receivable Follow-up 

  • Does the practice follow up on all outstanding balances: payer and patient?
  • Does the practice have a dashboard report that is reviewed monthly and compared to industry standards?

Source: Health Directions

Strategic Provider Planning, Specialty Mix