Bill Sample / December 8, 2018 / Alissa Mcmahon
You need an understanding with your providers as to when you are going to be paid for your services. Doctors are often not the best businessmen and are sometimes not very good about paying bills on time. Especially when you are first starting your business it is vital that your provider understands when you expect payment and that you have something well written to protect you if you end up with someone interpreting the language of your contract in court. Each year you are in business you find additional things that need to be added to your contract. New situations arise that you realize should be covered in your contract. So how do you cover everything that needs to be covered? You need a list - actually several lists. You need a list of what you feel the providers responsibilities are. You need a list of what you feel your responsibilities are.
Followup may take the form of a phone call to payer to discover a lost claim or to receive interpretation of denial message correction of earlier submitted data resubmission of the original claim consultation with the provider and medical notes or denial appeal. Both FPP and Denial rates are very important metrics often used for billing process improvement. The upside of FPP/Denial metric is that it is charge-invariant but its downside is that it hides the differences between process imperfections on the claim submission and claim payment sides. To identify patterns of problem CPT codes or payers FPP/Denial metric needs to be computed and compared across all pairs of payer-CPT code which is a standard feature for modern billing technologies.
Net collection rate is defined as a ratio of Total Collections and Total Charges less Adjustments. Gross collection rate is defined as a ratio of Total Collections to Total Charges only.) According to Medical Group Management Association (MGMA) 1998 Cost Survey adjusted fee-for-service collections (net collections) for family practices in 1997 averaged 98.65 percent. A declining net collection ratio may be symptomatic of increased contractual write-offs or insufficient number of denial appeals. This metric is especially useful in the absence of modern computer technology when comparison of every payment to allowed amount is impossible or when appeal process of denials is too expensive. Otherwise the use of charges in defining gross and net collection metrics precludes them from productive discovery of process improvement opportunities.