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New Practice Billing Toolbox Series 4 of 4: Systems and Processes


Main Points

  • The main processes that you need to establish are payment posting, claim follow-up, and eligibility and benefits checks

  • You need to document each process

  • You need an ability to measure your systems and processes

When you finalize your decision to start your practice and take insurance it will be important that you finalize your processes and procedures. Your processes and procedures will be the bedrock upon which your practice is built.

When it comes to building out your billing processes it will be important to have processes defining payment posting, claim follow-up, and eligibility and benefits checks.

If you have chosen your EHR at this point you will want to learn how to do each of these processes within that system. each system is a little different and will require specialized training on that system. However EHR companies have gotten really good add developing training for providers. Contact the support team at each EHR company.

Posting payments is the first process you want to document. The reason why you would want to do this first is because you would like to get an accurate picture of your outstanding balances.

Once you have posted all the payments then you already for claim follow up. You can decide to follow up on the claims based on age and amount. Most of the time you'll want to follow up on the biggest and oldest accounts first and then move to smaller accounts. But you will want to define how to document and track your activities so that you can remember what you did on each account.

After that you will want to figure out where you want to document eligibility and benefits checks in your system. Before each claim is submitted you should check the benefits of each patient so that you can update to deductibles and co-pays if needed.

Finally you will want to submit the claims. Being mindful of course of any modifiers that you may have.

With each process you will want to develop documentation that not only outlines the process itself but the work done within each process. There are a variety of ways to document processes and procedures. You can develop a manual, you can develop process flows, or you could do videos. However you decide to document your processes and procedures make sure you maintain them in a secure location.

After you have your documents and procedures developed you will want to determine how you were going to measure each process. Most commonly these measures are known as key performance indicators or KPIs.

You will want to measure how each process is performing so you know how your business is running. But most importantly you will want to know where you can develop and get better.

If you follow these simple steps you are well on your way to running a successful practice and a successful billing operation within your practice.

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