Four best practices to ensure your medical practice’s success in 2016

 In Articles, Provider Notes

It’s a New Year so let’s start it off right with FOUR best practices and tips that will help ensure your practice’s success in 2016.

1. Estimate and collect unmet deductible amounts using the Patient Estimator Tool OR Implement a CREDIT CARD On File Program

Many insurance plans start or renew on the first day of the new calendar year, which means deductibles for many of your patients are starting over too. Deductibles are a set amount the patient has to pay out of pocket for most services before his/her insurance starts paying. For this reason, we normally see a delay in revenue during the first quarter of the year because balances are left to patient liability.

You don’t have to wait on the patient to pay their bill if you estimate the balance and collect at the time of service. MSOC Health’s Patient Estimator Tool uses real benefit data from the insurance companies coupled with your contracted fees to get an accurate estimate of patient liability.

Reach out to your client analyst if you’re interested in implementing an up-front estimate policy or check out the instructional video here: Patient Estimator Tool.

An even more effective approach to collecting patient balances due involves implementation of a Credit Card On File (CCOF) program.  Best practices going forward involve estimating balances at time of service, capturing credit card on file information, and running cards for patient due portions as soon as you receive acknowledgement of claims processing.  We are interested in partnering with you to implement a CCOF program in your office.

2. Collect past due balances when the patient comes in for his/her next visit

Putting a policy in place to collect on prior patient balances can help boost your revenue. MSOC Health recommends reviewing your upcoming appointments for patients with large outstanding balances and collecting that money or setting up a timed payment plan at the next visit.

Your front office staff are the key to success here. Help them identify outstanding patient balances and effectively collect using the system tools and resources that work for you.  Your client analyst can help you identify the best reports or place within your workflow to identify balances owed for upcoming appointments. 

Asking patients for money can seem like a daunting task, but it doesn’t have to be. Use the Patient Collections scripts developed by MSOC to help your front office staff become more confident when collecting patient balances.

Sample Collection Scripts

3. Get copies of new insurance cards and scan the images into your PM system

When entering new policies, utilize the effective to and from dates to ensure your new claims go to the correct policy. Quick guides for entering insurance policies in your PM system can be found below:

Clinix Insurance Entry Job Aid

AMD Insurance Entry Job Aid

Review the card for notations about PCP referral requirements and obtain referrals if needed.

4. Make sure you know the payor updates

A. MedicareMedicare Part B deductible is going up for the first time in several years. For 2016 the Medicare Part B deductible is $166.

B. Blue Cross NC – New Blue Cross NC Member ID Prefixes

Blue Cross North Carolina has migrated individual members under 65 years old to its new technology platform and as a result you’ll start seeing new member ID prefixes on some policies effective 1/1/2016.

Some key changes you should be aware of are:

  • The “subscriber” suffix will now be 00, the “dependent” suffix will now be 01, and so forth.
    • If you get errors on an eligibility response, check the prefix to make sure it’s correct.
  • New ID numbers will no longer have a four letter prefix ending in “W” or “J”. Instead the prefix will be only three letters.
    • For Clinix users, if you get a pop-up warning stating the policy number you’ve entered in the insurance record doesn’t match the normal format, please click OK to override.
    • If you find the warning is having a negative impact on your workflow, please reach out to your Client Analyst.
  • Members who have not yet migrated to the new platform will continue to have the four letter prefixes in their ID numbers.
  • New cards will be made of hard plastic rather than paper.

See below for the new member alpha prefixes:

  • New alpha prefixes for individual members (under 65):
  • Blue Advantage®: YPN (non-Exchange) and YPI (on Exchange)
  • Blue SelectSM: YPT (non-Exchange) and YPA (on Exchange)
  • Blue ValueSM: YPJ (non-Exchange) and YPJ (on Exchange)
  • Blue LocalSM With Carolinas HealthcareSystem: PVY (non-Exchange) and PVX (on Exchange)
  • Blue Local With Duke and WakeMed: DQV (non-Exchange) and DQW (on Exchange)
  • Office of Personnel Management Multi-State Plan: MZS (on Exchange)

Existing small group alpha prefixes:

  • Blue OptionsSM: YPS (non-Exchange) and YPR (on Exchange)
  • Blue Select: YPQ (non-Exchange) and YPG (on Exchange)
  • Blue Value: UPU (non-Exchange) and YPE (on Exchange)

For more information, please review the full provider announcement on BCBSNC.

Does Athena or your billing company offer you these benefits? This is a sampling of what MSOC Health offers its clients. Contact us today to learn more.

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