Nov 26, 2024
Apr 3, 2025
Written By Elizabeth Cifers
Optimizing coding and billing processes is essential to a successful retina practice. It reduces errors, speeds up reimbursements, and minimizes denials. By implementing best practices and streamlining processes, you can maintain a strong revenue cycle and ensure efficient operations. Here are ten proven best practices for coding and billing in your retina clinic, ranked by importance, to maximize financial health and operational efficiency.
1. Perform Monthly Month-End Close and Reporting
Month-end close is crucial for providing an accurate snapshot of your clinic’s financial health and ensuring all transactions are posted correctly. Failing to close monthly can lead to discrepancies and missed revenue opportunities. If your practice management software has a month-end close feature, be sure to utilize it, conduct reconciliations to ensure all charges, payments, and adjustments are posted accurately, and run financial reports to track key performance indicators (KPIs). Regularly comparing month-over-month performance helps identify financial variances early on.
2. Conduct Daily Insurance Billing
Submitting insurance claims daily ensures a steady cash flow, reduces claim processing time, and minimizes billing backlogs. Prompt submission increases early detection of payer-specific issues and decreases the risk of aging accounts receivable (AR) and write-off risks for timely filing. As a best practice, charges should be coded and submitted within 1- 3 days of service. Scrubbing the claims before submission to verify coding accuracy reduces errors and rejections. Monitoring claims through payer remittance modules is critical for tracking updates and denials.
3. Conduct Patient Billing Weekly
Timely patient billing promotes quicker payments and reduces AR balances, which is vital for maintaining a healthy cash flow. Delaying patient statements can lead to collection challenges, so establishing a consistent weekly billing cycle helps keep patients informed of their financial obligations. Offering online payment options makes it easier for patients to pay promptly. Include clear explanations of charges, due dates, and payment methods in all patient statements.
4. Complete Eligibility Verification 24 Hours Before Appointments
Verifying insurance eligibility about two weeks and at least 24 hours before the patient's appointment can help prevent coverage issues such as an insurance change and reduce claim denials. Using electronic eligibility tools integrated with your practice management system, confirm coverage, co-payments, and any pre-authorization requirements. Communicating uncovered costs or coverage issues with patients beforehand prevents disruptions and delays.
5. Monitor Collection Ratios and Compare to Prior Years
Tracking your collection ratio over time helps assess the effectiveness of revenue cycle processes. Variances may indicate payer delays, coding inaccuracies, or systemic issues that need immediate attention. Calculate your net collection ratio monthly and compare it to the same periods over previous months and years to identify trends. Investigating significant dips and their causes is essential. Regular meetings with the billing team ensure issues are found, and solutions are promptly implemented.
6. Use Every Payer Remittance Module Available
Leveraging all available payer remittance modules will streamline payment and denial processing, helping you quickly identify denial trends and address potential issues. Implementing electronic remittance advice (ERA) modules for all payers allows you to regularly review remittance reports, identify denial causes, and swiftly appeal denied claims. This also reduces manual data entry and accelerates payment posting.
7. Limit AR Over 90 Days to Less Than 15% of Total AR
A high percentage of AR over 90 days can signify collection inefficiencies or payer issues. Keeping this metric under 15% ensures cash flow stability. Prioritizing and monitoring AR aging reports identifies delinquent accounts for prompt resolution. Dedicated staff should follow up on outstanding claims and patient balances. Ensure policies and procedures are in place for timely resolution of any payment issues.
8. Keep DSO Under 45 Days
Take time to closely monitor and manage Days Sales Outstanding (DSO), which measures the average number of days to collect payment for services rendered. Maintaining a DSO of under 40-45 days is ideal, as a higher DSO (90+ days) can increase the risk of unpaid balances and revenue loss. DSO helps track payment collection speed, identifies late payers, and provides early warnings of potential issues. Key strategies to reduce DSO include ensuring accurate documentation, timely claim submission, consistent follow-up on outstanding claims, and clearly defined patient payment terms. This approach promotes stable and predictable revenue flow.
9. Electronic Deposits to the Bank
Utilizing Automated Clearing House (ACH) to receive all payer payments can ensure secure and prompt accounts receivable payment deposits, reducing cash flow delays and manual errors. Verifying daily deposits before auto-posting the payment can help maintain financial accuracy. Daily reconciliation with your practice management system ensures that all payments are correctly recorded.
10. Use Web-Based Data Backups
Data security and availability are crucial for smooth coding and billing operations. Scheduling regular web-based backups for all essential data ensures recovery during a disaster. Work with your IT vendor to create a backup schedule that could be as often as every 30 minutes to log any changes made in the system. Periodic testing of data recovery processes verifies their effectiveness, and transitioning to a cloud-based system can further enhance data security and accessibility – even cloud-based systems must have a data backup to stay compliant with Health Insurance Portability and Accountability Act (HIPAA) privacy and security rules.
Conclusion
Implementing these ten best practices in your retina clinic can optimize coding and billing processes, enhance cash flow, and reduce revenue cycle inefficiencies. By focusing on accuracy, timely processes, and proactive monitoring, you can strengthen your clinic’s financial health and operational efficiency for a more predictable and robust future.
If your retina practice seeks to enhance efficiency and optimize revenue, Elizabeth Cifers is ready to assist. With decades of expertise in the medical industry, including 13 years dedicated to the retina field, Elizabeth specializes in streamlining clinical operations and improving the revenue cycle. Her extensive, hands-on experience can transform your practice's workflow and financial performance. Book a free consultation here to explore how Elizabeth can help your clinic achieve its goals.
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