Financial Coordinator Checklist Explanation and Job Duties in Depth

Transcription

1 Financial Coordinator Checklist Explanation and Job Duties in Depth This document outlines the duties of the financial coordinator with explanations as to what each step/duty is and why it is important. NEXT DAY REVIEW WHAT THIS MEANS: This is reviewing the future schedule to verify the balances of patients to make sure the office collects anything outstanding when the patient is in the office. HOW IT IS DONE: Look ahead at least one day but preferably two days in the schedule and quickly check the account of each patient. If the patient has either a balance or any outstanding claims that have not been paid yet but should, review the status of the patient and handle accordingly. If the patient has balance due, make sure that the accounting for that patient is correct and that it is the correct balance to collect. Make sure there are notes in the appropriate place to ensure that they person checking the patient out knows why there is a balance and that it should be collected on. If claims are still outstanding and they should have been paid on already, call insurance company to get the status to get them paid and/or to be able to update the patient when they are in on the status of the insurance claim WHY IT IS IMPORTANT: Collecting on a balance is much easier when the patient is in the office. Also, the number one complaint about dental offices online are the accounting issues and patient balance issues. By reviewing the account a day or two before a patient is in the office will allow you time to make sure it is correct and be ready to talk to the patient about it when they are in the office. When other employees have a clear understanding as to why there is a balance for the patient, the percentage of getting that patient to pay while they are in the office goes way up versus not knowing why there is a balance and the patient wanting to know before they pay. When that happens, many times patients leave the office stating they will pay when the balance is figured out, which means then the patient needs to be tracked down in the future to get them to pay. BASIC PATIENT ACCOUNT TERMS: Debit transactions (transactions that increase the patient's balance) Outstanding insurance claims (appear in typically in blue) claims that are not paid yet Credit transactions (transactions that decrease the patient's balance) Adjustments are anything done within the account to either increase or decrease the patient s balance Write Offs are when a balance is written off and no longer plan to be collected Completed Service is done when the service is completed for a patient Insurance Payment is entered when insurance claim is paid and will typically close the claim and reduce the amount to the patient s account

2 Account Payment is the payment made by the patient which lowers their balance If the office waits too long, the patient tends to forget they received the insurance EOB and question why they have a balance. BASIC INSURANCE TERMS: Insurance claim is what is submitted to the insurance company to get them to pay for procedures completed Explanation of Benefits (EOB) is the form that is sent to the office with an explanation of how much they paid per procedure and why ENTERING INSURANCE CHECKS WHAT THIS MEANS: Each day the office more than likely will receive checks from the insurance company and they need to be entered into the patient s account. HOW IT IS DONE: Each check is opened, entered into the patient s account by following steps in software to enter insurance checks. When entered correctly, the payment will correspond with the appropriate open claim for the date of service and the procedures done. When the check is entered correctly, a few things more than likely needs to take place: The correct amount of the payment that connects to the correct procedure and date of service. The % of coverage for that procedure needs to be verified in the software so that going forward when this procedure is done again for this insurance group, the estimate given to the patient is as close as possible The coverage book/payment table gets updated which is a list of the actual amounts that the insurance company pays for the procedure, which overrides the % to get an even more accurate estimate of what this plan pays going forward Any adjustments are made to the account, such as in network adjustments if your office participates with the insurance company Verify balance remaining for patient is correct and a note in the insurance note if the insurance did not pay what was estimated and why If patient has balance remaining, a statement is generated to be sent to the patient (check your office policy) EOB is scanned into the patient s document section for future reference WHY IT IS IMPORTANT: Entering insurance checks can be time consuming and accuracy is VERY IMPORTANT. It is important that when entering insurance checks correctly the following information is verified: the correct patient, the correct date of service, the correct service, the reason why insurance paid less than expected, the correct adjustment is made, the balance is correct after insurance check is entered, the notes as to why the insurance paid less and the explanation for the balance is accurate, and the EOB is scanned into the correct patient s document. This data needs to be entered correctly because patients will want to know where their balance is coming from and having this done correctly will help to make sure that the patient pays. The number one complaint about dental offices is about billing and so making sure yours is done accurately will help to give the patient confidence in your office. Also,

3 as more and more claims are paid by an insurance plan, when the software is updated correctly, you can get a closer amount estimate of what the insurance should pay, eliminating the need to balance bill the patient after. It is suggested that the patient receives a statement from the office relatively soon after the EOB is received from the insurance company, since the patient receives one also. This will increase the patient paying the bill to the office quickly, as they just received the statement from the insurance with the explanation of why they owe. % Covered is the % that the insurance pays per procedure grouping such as 100% for preventative, 80% for basic and 50% for major Coverage book/payment table is an area where the actual $ amount the insurance paid for a procedure can be entered. This gives a more exact $ amount that they will pay based off what they paid for this procedure and overrides the % covered o Example: If the insurance company says they will pay 100% for D1110 then if your fee is $109, you should get paid $109 from the insurance company. However, if the insurance company has a lower fee schedule then they might only pay $102 for D1110 because that is their allowed fee. Once the office receives an EOB that shows their allowed amount is only $102, then entering that into the coverage book/payment table will now estimate only $102 for patients in this group in the future that get this procedure done. Primary Insurance is the plan that will pay first for a patient that has more than one insurance Secondary Insurance is the insurance company that will pay after the primary insurance company pays on a claim. Not all plans work together however, so it is important to know how the secondary insurance will pay after primary pays Coordination of Benefits is the term used to explain how primary and secondary insurance work together. If they coordinate benefits, that means that they will work with one another and usually the secondary will pay a portion of what the primary insurance did not PRINT OUT DEPOSIT REPORT WHAT THIS MEANS: This is a step to verify that the amount entered into the software is correct and matches the checks received that day. HOW IT IS DONE: Pull the appropriate report that shows checks entered into the software and compare that to the checks entered that day to verify the amounts match. This should be done by the person who entered them prior to handing the checks off to anyone else to make sure they are entered correctly and if not, fixes are made. WHY IT IS IMPORTANT: It is important that the person who enters the checks verifies the final amount so that if there are any mistakes, they can be fixed. This should be done prior to anyone else receiving the deposit/checks because it is much easier to find the mistake when they are that this point in the process, not later in the process when there are all payments made during the day are combined for end of day reporting. It is important to account for each and every payment made to the office on a daily balance and verify the amounts are correct before the day can be completed.

4 BASIC DEPOSIT TERMS: Insurance Payments are any payments made by an insurance company Over the Counter Payments are any payments made by patients while in office Patient Payments are any payments made by patients, such as over the counter, over the phone or in the mail and can be checks or credit card payments Primary Deposit Report (or might be another name depending on software) are check and cash payments that go into bank account. Secondary Deposit Report (or might be another name depending on software) are credit card payments and finance company payments, such as payments made via Care Credit SEND STATEMENTS WHAT THIS MEANS: Statements are bills sent by dental office to the patient that has a balance to be paid. HOW IS IT DONE: Depending on the software, it can be done various ways, however the basics of sending statements should be at least one sent to patient soon after the insurance check is entered and then sent at least monthly after that until the balance is paid. Refer to office software to find out how that is done. WHY IT IS IMPORTANT: It is important that statements go out to patients immediately after the insurance check is entered, since the patient more than likely also received an explanation from the insurance company about what they paid and why. By sending a statement to the patient soon after they received the EOB from the insurance, it puts more responsibility on the insurance company as to the reason they patient has a balance. For example, if the insurance company downgraded their payment on something, then when the patient receives the bill, they will tie that balance to their insurance company not paying, versus later when they forget they received that EOB and then get upset at the office because of the balance. BASIC TERMS: Statements are the bill that gets sent to the patient when they have a balance to pay MONTHLY BATCH OF STATEMENTS As stated above, patients should receive a statement from the office on a monthly basis. Also, depending on office policy, a phone call to the patient to discuss their payment is recommended.

5 SCAN EOBS WHAT THIS MEANS: (this pertains to a paperless office or one attempting to become paperless). When the Explanation of Benefits is received from the insurance company, it needs to be put into the patient s chart and/or their document /scanned docs area. HOW IS IT DONE: Refer to your own dental software to know how to scan the document into the patient s account. Scanning is an easy task but is time consuming and many times overlooked. If not done in a timely manner than it can quickly pile up, so it is suggested that it get done as they are received. WHY IT IS IMPORTANT: As mentioned above, it is easy to fall behind on scanning, especially when a lot of checks are received in one day, for example. The reason it is important to do the scanning in a timely manner is that then everyone in the office has easy access to that document. The reason that is important is that if another team member talks to the patient about their balance or what the insurance did or did not pay, they need to have that information in front of them to be accurate in what they tell the patient. If the EOB ends up in a stack of papers, the person won t be able to find it easily and/or might inform the patient incorrectly, which in the long run might make the patient man and lower the chance of the dental office getting paid. BASIC SCANNING TERMS: Document Center or Scanned Docs (or might be called something different depending on the software) is the location where documents are scanned in, titled and saved for future reference SEND CLAIMS WHAT THIS MEANS: When a procedure is completed in the patient s chart, if the patient has insurance, a claim is generated. The claim is then sent to the insurance company in order to get them to pay their portion for the procedure. Some claims, such as cleanings can be sent as is with not extra documentations however some procedures, such as endo require more information, such as radiograph and narrative. Claims should be sent on a daily basis to ensure that the office receives insurance payments regularly. WHY IT IS IMPORTANT: It is important that the claims be processed daily or at least every other day to make sure the office is regularly receiving insurance payments throughout the month. It is also important to know what needs to accompany different procedures in order to increase the chance of getting the claim paid and not kicked back requiring more information. HOW IT IS DONE: Refer to the dental software or third party system your office has that processes dental claims. One suggestion is to have a cheat sheet with what is required for each code that is sent to insurance companies and to make

6 sure that the doctor enters the notes needed to help with narrative within a 24 hour period so the claim does not get held up waiting for information to submit the claim. BASIC CLAIM TERMS: Claim is the document sent to insurance company to show the procedure that was done and in an attempt to get them to pay Narrative is the description required by the insurance company for some procedures before they will pay for the procedure Documentation is whatever more the insurance company requires in order to pay for a procedure, which could include an x-ray or a narrative CALL ON OUTSTANDING INSURANCE CLAIMS Once a month, minimally any insurance claim that is outstanding for over 30 days should be called on to find out the delay in payment in order to get the insurance company to pay. This can be done by the insurance coordinator or delegated but every open claim should be called on once a month and follow up on to get the insurance company what they need to get the payment made. POSSIBLE REPORTS TO PULL TO MONITOR THIS AREA Each software is different but there are certain types of reports that can be pulled to monitor this area of the practice. Below is a list of types of reports (though the names might vary and what they report) DEPOSIT REPORT these reports show the payments made for a certain time period, such as at the end of the day to balance the payments received with what was entered into the software OUTSTANDING INSURANCE this report will show the insurance claims that are outstanding and still need to get paid to the office. It is recommended to look at this report for claims over 30 days old, as usually under 30 day insurance claims are still in process ACCOUNTS RECEIVABLE BY RESPONSIBLE PARTY this report will show the balance of each family, how overdue they are, how much is estimated still to be paid by insurance and the total amount of money due to the practice COLLECTIONS RECONCILIATION this will show all the collections (money received) into the practice during a certain period of time. This can be used to find mistakes, watch that collections are being entered correctly, etc