Accounts Receivable: The Medical Biller’s Secret Ethical Weapon

By Karen Smiley

When patients have trouble meeting their financial responsibilities or physicians fail to document, as the medical biller you may be asked to let payments slide or to go ahead and code an encounter that has no documentation. Fortunately, you have a secret weapon you can rely on to drive home the point that fudging just won’t work: accounts receivable (AR).

Outstanding revenue needs to be collected (no one knows that better than your boss) before it can be used. Allowing patients to make installment payments is an option, but it increases the AR line on the balance sheet, and the provider can’t invest money that hasn’t been received, nor can he make payroll until the money is in the bank.

The way to avoid this problem is to encourage the provider to collect all known deductibles, anticipated co‐insurance amounts, and copayments before the patient encounter and to make patients aware of this practice prior to the date of service. That way, they’re prepared to make payment when they arrive.

On the other end of your process is the provider who fails to document. Sure, he may see 75 patients a day with an average of $100 payment per encounter, but if he doesn’t dictate until he’s faced with the threat of privilege revocation, he can’t get the money he obviously wants.

Providers like this need to be reminded that they can’t get paid until the claim is submitted, and the claim can’t be submitted without the documentation. If pressured to fudge your coding process, remind such docs that you won’t be able to pursue unpaid claims in AR without the proper provider documentation anyway, so getting paid won’t even be an option. That tends to get their pens moving!