Summary of presentation from Rebecca Lamb with PedsOne at a previous PMI Conference
Managing insurance Accounts Receivable (A/R) is a critical aspect of running a successful medical practice, particularly in pediatrics. In a recent comprehensive presentation by Rebecca Lam, experts and peers discussed the multi-pronged approach needed to streamline insurance claims, minimize denials, and ensure timely payment. The journey toward A/R excellence is filled with practical challenges—ranging from out-of-date insurance cards to intricate payer denial codes—but by adopting proven processes and digital tools, practices can work smarter, reduce stress, and boost cash flow.
**The Importance of a Team-Based Approach**
Insurance A/R isn’t just the responsibility of billing staff; it’s a collaborative effort that begins at the very first patient interaction. The front desk plays a pivotal role, from collecting and scanning insurance cards (front and back!) to updating patient demographics and checking current eligibility at every visit. Small oversights at check-in, such as missing secondary policy information or outdated insurance details, can cause downstream headaches for billers and delay payments for months. Ensuring front desk teams are fully trained and routinely reminded of best practices is foundational for a healthy revenue cycle.
**Utilizing Technology and Streamlining Billing Workflows**
Modern payer websites and digital tools have changed the game for billing departments, allowing for claims corrections, appeals, and documentation uploads to happen online—often much faster than waiting on hold for a phone representative. Leveraging these tools effectively, such as payer-specific portals, claim correction features, remittance viewers, and chat support, can significantly reduce turnaround time and help resolve denials efficiently. Creating shared resources like an insurance “cheat sheet” or spreadsheet that captures the quirks and requirements of each payer is invaluable for both training and daily operations.
**Proactive Problem-Solving for Denials and Complex Claims**
Denials are inevitable, but knowing how to address them is key. Timely claim submission and a routine, structured approach—whether working old claims, payer-specific denials, or batches of common issues—enables billing teams to manage workload and avoid missing timely filing deadlines. Billing leads recommend analyzing denials in bulk (e.g., all COVID vaccine denials or twin denials) and using payer tools to dispute or correct claims whenever possible. For persistent problems, escalating to provider reps or even using state and professional society resources (like the “hassle factor” form) can lead to systemic fixes and retroactive payments.
**Communication, Documentation, and Compassion**
Effective claim processing and patient billing rely on copious documentation—not just in the practice management system, but also in patient accounts and communications with insurers. Taking diligent notes, tracking reference numbers, and maintaining clear records streamlines follow-ups and defenses for appeals. At the patient level, communication and empathy are paramount. Billing staff should be prepared to explain insurance policies and bills in plain language, listen to concerns, and offer payment plans or solutions when possible, recognizing that most families don’t fully understand their benefits and may feel overwhelmed.
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**5 Practical Takeaways for Improving Insurance A/R:**
1. **Start at the Front Desk:** Train front desk teams to consistently collect, scan, and verify both sides of insurance cards, update patient demographics, and check eligibility with every visit.
2. **Harness Digital Tools:** Get staff registered for payer portals, use electronic claim correction and dispute features, and maintain spreadsheets listing key payer rules and quirks.
3. **Work Denials Systematically:** Carve out dedicated time weekly or biweekly to address outstanding claims, focusing on the oldest or most urgent issues, and analyze denials by pattern or payer.
4. **Document Everything:** Enter comprehensive notes—reference numbers, outcomes, actions taken—into your billing or EHR system, making sure all claim corrections and communications are traceable.
5. **Educate & Communicate:** Proactively inform new parents and patients about insurance deadlines (like adding newborns to a policy), clarify benefit limitations, and handle billing calls with patience and empathy.
By weaving these strategies into practice operations, clinics can transform their insurance processes from the overwhelming “chocolate factory” experience into a streamlined, effective system that supports both financial health and patient satisfaction.