When Dealing with Insurers, Electronic Payment Tools May be an Otolaryngologist’s Best Friend

We don’t look so much at the number of days it takes to pay as much as the contracting rate of pay, said Roger Crumley, MD, MBA, Chair of the Department of Otolaryngology-Head and Neck Surgery at the University of California, Irvine School of Medicine.

On the other hand, Dr. Crumley added that it’s known in the health-care field that the sooner you collect your money, the higher the chances of collecting at all.

Lee Eisenberg, MD, a private practice otolaryngologist in Englewood, NJ, doubts the survey will be helpful. Some insurance companies don’t pay well and we know that. It’s not rocket science; it’s just practical experience.

So, What’s a Doctor to Do?

The first step toward achieving fair, accurate, and timely insurance payments is effective insurance negotiation, said Jane Dillon, MD, a private practice otolaryngologist in the Chicago suburb of Hinsdale, Ill., and a physician with Adventist Midwest Health’s Hinsdale Hospital. If you don’t have in-depth experience with this process, find someone who does.

The key to accurate, timely insurance payment is the type of billing system used by otolaryngologists, Dr. Eisenberg said. Noting that electronic claim systems are the way to go, he recommends software add-ons called claim scrubbers that look at every field in a claim, correcting data input errors and ensuring that a clean claim is sent to the insurance company.

Dr. Crumley agrees. Unfortunately, some insurance companies do whatever they can to delay or deny payment. If there’s one typo, they might wait a month before sending it back for correction. It has to be a clean claim and electronic billing systems with scrubbers can do this.

However, the high cost of electronic billing systems has prevented many physicians from implementing them. Dr. Eisenberg suggests that solo practitioners or small groups might want to partner with others to form a group large enough to split the costs. Think outside the box and figure out a way to do it, he said.

Dr. Dillon credits her group’s membership in two local physician hospital organizations (PHOs) for improved business relationships. The physicians work together with the hospitals, and I think the insurance carriers respond quite well to hospitals. She adds that the PHO meets with insurance brokers and employers to tell them which insurance companies are doing the best job.

One Approach to Electronic Billing

As for the electronic side of their business, Dr. Dillon said the accounts receivable (A/R) days, or average time it takes to get a claim paid, have been cut in half, from more than 60 days to about 30. Her group’s system works like this:

We plan to implement a system where a patient office visit is immediately coded and sent to the carrier while the patient is being seen. The carrier will tell us how much they’ll pay, and we’ll be able to collect the remainder from the patient as he or she leaves the office. – -Jane Dillon, MD