Is It Time to Go Home Yet?
A CAs job is never done. Offices need to have systems and procedures in place that will manage both outbound claims, inbound checks, and accounts receivable. At any given time, there are claims in various stages of the billing cycle that must be managed. Throughout the day, new claims are being created, patients are paying their co-pays and deductibles at the front desk, and insurance payments are coming in via the mail and Electronic Funds Transfer (EFT). By verifying that these amounts match at the end of every shift/day, you ensure that your office runs more effectively and efficiently.
Leave No Patient Behind
The office should have a sign-in sheet, electronic check-in, or other method to track the patients seen that day. This is the first of many checks and balances you can use to make sure all your patients have been accounted for. If a scheduled patient is not on the sign-in sheet, dig deeper to determine if the patient missed the appointment that day or just forgot to sign in. This allows you to call your no-shows and reschedule. If they just forgot to sign in, make sure you have a routing slip for them so you can enter their charges into your system.
There are advantages to using paper routing slips, even if your office uses Electronic Health Records (EHR). Best practice includes using a routing slip or encounter form to communicate the services that were rendered to ensure proper coding. This step is critical to a compliant office. The treatment activity must be reflected precisely in the documentation that must exactly match the coding used to represent the patient encounter. In some instances, the person who enters the charges into the system does not have any interaction with the patient during the treatment, making it difficult to know what services were performed. By using a routing slip, the doctor can easily relay this important information to other team members. In cases where the procedure codes are entered by the doctor at the time of service, the routing slip is another tool that allows you to double-check your work.
Adding it Up
Incoming payments from patients and 3rd party payers must also be accounted for and reconciled. It may be your policy to print a copy of a receipt related to patient payments. If so, this will help you separate payments into piles for cash payments, checks, and credit cards that can later be matched up with all monies collected for the day. Count any petty cash on hand used to make change for patients. Ensure that no money is missing and that you have a variety of denominations available for future use.
Insurance payments by check and EFTs should also have procedures associated with them. Make copies of the insurance checks before they are deposited in the bank. Verify that all EFT payments have been received. Since EOBs/ERAs may not be posted into your billing system on the same day received, ensure that they are stored in a safe place until they can be entered.
Double Checking Your Computer Entries
Computers have been known to make mistakes; however, errors are generally the result of humans. Therefore, it is critical to take a step back and double-check your work. Total all the charges from the routing slips and compare that to the total charges entered in your billing software. If the total does not match, retrace your steps to verify that you have accounted for all the patients and services billed. If you have also posted patient or insurance payments, verify that they match as well.
Making the End of Day Process Work for You
Every office is different, and the end of day process should be customized for your needs. Offices with a larger patient volume may want to start adding up payments and double-checking charge entries before lunch. This way, if a payment is missed later in the day, there are fewer routing slips or receipts to review to find the error. You may also find it helpful to use a calculator with a paper tape or a computer spreadsheet to manage all your entries. Once you are sure everything has balanced, create your end of day bundle with all the day’s paperwork and store or scan it by date in a secure location. Any checks or cash should be safely kept in a designated location until deposited in the bank.
KMC University has a great tool called the “End of Day Balancing Form.” As a Library member, you can find this and other important forms through your dashboard.
Having end-of-day procedures for your billing department is just as important as remembering to turn off the lights or lock the doors after the last patient leaves. Your office will feel confident that there are no errors for that day and will be ready to start the next day fresh and prepared to focus on the tasks that lie ahead.