Standard Operating Procedures and Best Practices

Standard Operating Procedures and Best Practices

Registration / Front Desk

Scheduling, Registration, and Front Desk are financial functions. Make sure you and all users are trained on these Best Practices.
Focusing on the front end of the Revenue Cycle makes a big impact on end results and your practice’s ability to get paid for all services.
  1. The Job Scheduler can be used to automate many of these tasks.

Improve Registration Quality and Collections

  • Verify benefits and eligibility 24-48 hours before the Appointment.
    • All Patients should have one default Insurance Profile or be marked Self Pay.
    • The patient should be stopped during front desk check-in or before if:
      • The Patient is not eligible.
      • Their coverage was terminated or inaccurate.
      • There is a Collection Balance on Account.
  • Patient Identification: Verify each time the Patient arrives. For example, is your address still XXX Main St.
  • Identify Workman's Compensation:
    • Paperwork should be reviewed and the Case added.
    • Confirm the Case is assigned to the appointment.
  • Collect the Payment for all Patient Responsibility amounts at the time of service.
  • Mark all patients who do not attend their appointment as NO SHOW.

Daily Reports and Actions

Daily Reports

  1. Reference Batch

  1. Reconcile Receipts per cash drawer.
  2. Reconcile Charges.
  3. Close Reference Batches after the Daily Reference Batch Reports has been reviewed by the user. This acts as a sign off by the user.
  4. Some clients prefer to have separate Reference Batches for:
    1. Each User
    2. Refunds
    3. Claims Corrections
    4. ERA Payment Posting
    5. Manually Posted Payments
    6. Charges
  1. Encounter by Status

    1. Review and work (correct and resubmit) Clearinghouse Rejected, Payer Rejected, and Local Edit Errors.
  2. Receipt Management

    1. Use as a bank deposit reconciliation.
  3. Daily Sheets

    1. Use to check all financial activity for the day (such as charges and receipts).

Daily Actions

  1. Open Reference Batches to manage financial transactions. Review and Close at the end of the day.
  2. Manually Batch and Upload Statements (use the job scheduler to electronically auto-upload). Manage Clearinghouse and Payer Rejections.
  3. Post Manual Insurance and Patient Payment upon receiving.
  4. Post ERA on the Received Date. Post Medicare payments first.
  5. Review Custom Worklists if you are using them and Denial Worklist for action items.
  6. If Charges are automatically created from your clinical documentation, make sure there are no mappings to resolve.

Weekly Reports and Actions

Weekly Reports

  1. Interactive Aging

    1. Work this list for current Outstanding Insurance Balances (A/R). Outstanding Patient Balances are also shown on this report.
    2. The Interactive Aging button is located on the Home Dashboard.
  2. Unresolved Claims Report

    1. For balances to Insurance, use this report as a call list.
    2. Filters are available to search specific Insurance, Balance, Aging, Percentage, etc.
  3. Aging by Patient

    1. For Outstanding Patient or Insurance balances and Credit balances.
    2. Responsibility Date: The date that the party became responsible for the balance. For non Self-pay patients, it is the date the balance was transferred to the patient. If Self-Pay, it is when the charge was posted.
  1. Missing Encounters

    1. If you are using the Calendar, use this as a check and balance. If the patient kept an appointment, do we have an encounter (charge) in our system?

Weekly Actions

  1. Upload files before 1:00 PM EST. Best days to upload are Monday-Thursday, to avoid delays over the weekend. Review the Statement errors in the Address Corrections - Needs Changed / Do Not Mail panel.
  2. Review RCM reports such as Interactive aging, Unresolved claims, and Aging by Patient.
Some smaller practice's may prefer to send statements on a monthly schedule.

Monthly Reports and Actions

Monthly Reports

  1. Receipts Management

    1. Use as an audit for receipts received, payments posted, and any money in escrow.
    2. Make sure all Insurance escrow is posted before you run end-of-period reports.
    3. Reconcile credit card statements.
  2. Aging by Patient

    1. Review patient credit Patient Credit Management.
    2. Review high, unpaid balances.
  3. A/R Management

    1. Days in A/R: Total A/R divided by the average billed amount per day over a time period.
    2. Net: (Charges - Payments - Adjustments - Transfers + Refunds)
  4. A/R Analysis

    1. Compare month to month and see the beginning and ending A/R.
  5. Practice Analysis & Closing

    1. The number of Patients seen and the number of Encounters.
    2. All Charges, Payments, Adjustments, Write-offs, Refunds, and RVUs.
    3. Transfers: The money moved (transferred) from/to the next responsible party.

Monthly Actions

  1. Review Incomplete Charges to see if it is possible to complete them.
  2. Review Patient Refunds and Insurance Credits for Refunds that need to be made or to Re-apply a Patient Credit.
    1. The Aging by Patient or Interactive Aging Reports can be used for this purpose.
    2. Close the financial period.

Collections Reports

  1. Pre-Collections Report

    1. The User can System generate or create your own.
  2. Aging by Patient

    1. Use as a call list for Pre-Collection efforts.
  3. Collection Agency Spreadsheet

    1. Use to send accounts to a Collection agency.

Yearly Reports

  1. Period End

    1. Year End is assumed to be a calendar year (Dec 31). If you close at a different month check end of year.
    2. Taxes Collected, if used.

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