Direct some of the attention that you've paid to EMR implementation to your business office and you'll likely make significantly more than the stimulus money if you do so.

Here are specific steps to take and companies to contact. Using their services will lower your accounts receivable (AR) and increase your cash flow. We know for certain, based on hospital and medical association surveys, that patient debt is rapidly rising. Surprisingly, the fastest growing segment of patient debt is not among the uninsured, but among those with insurance. Ever increasing deductibles and coinsurance payments are a heavy burden.

Is this a problem in your office?

Unless you check a few reports you won't know.

ACTION STEP: Ask your staff to run a patient-only accounts receivable report. Age the AR beyond the usual 120 days to 150 and 180 and beyond. The acuity of the problem will be self evident.

Look at the size of the balances. If you see a significant number of accounts that are $50 or less, it is a sign that the checkout desk needs training and more supervision. It's silly to have billing expenses because the staff can't or won't effectively collect on copays and coinsurance.

Make sure that patient statements are sent out monthly - not occasionally. In five client practices, this year alone, we've discovered that for a range of weird reasons patient statements were NOT being mailed. Unacceptable!

Insist on receiving a chart each month showing the number of patient statements mailed.

Our consulting experience shows that by using all or some of the features of these technologies that big improvements are possible:

A solo physician reduced the number of inactive patient accounts over 90 days old by using the recurring payment feature offered by Solveras Payment Solutions. Using this option, patients agree to pay you by credit card (weekly or monthly) or agree to a checking account debit for a certain amount. It's not hard to set up. Unfortunately, medical practices have been slow to adopt the tools used by mortgage companies, Netflix, utilities, gyms and churches. The payments auto transfer to your bank account. This surgical practice now has 35 patients on payment plans, with an average payment of $40 per month. Prior they had 35 "promises to pay" that weren't kept.

Offer payment options on your Web site. A "virtual terminal" or Web-based payment option is a must, particularly if your patient population is younger. The under 30 demographic cohorts don't have checking accounts; they are accustomed to automatic bill pay, and if you want to be paid get on the system.

Because they are endorsed by a number of national specialty societies (including ASPS and AAFP), we recommend Solveras.com. Check them out. They'll also do a free assessment of whether you're in-office credit card processor is giving you the best deal. On average they've saved KZA clients $1,500 annually. That's more than a full day of new patient office visit revenue!

What else?

Collect insured patient responsibility amounts before they leave the office! Yes, you can. Real time claim adjudication makes it possible. It means the checkout staff will handle functions previously done by the billing team. Here's how it works. You see a patient. Staff posts the codes for the visit, imaging, injections, and charges. The data is transmitted to the insurance carrier. The payor adjudicates the claim in real time, sending your staff a message about what to collect. The patient then pays what's owed on their deductible, copays, and coinsurance before leaving the office. If they are "short," ask them to sign up for recurring payment. It eliminates, "I'll pay you when I get home." Patients can't argue because a piece of paper can be printed with their name, policy number and amount owed right there at the front desk. It's true!

Call your clearinghouse to see if they offer this function for the dominant payors in your market. Companies like http://www.realmed.com and http://www.availity.com do a superb job. Check with your clearinghouse. Some practices have found that for maximum result they need to deal with two clearinghouses. The cash return more than justifies the expense.

While it's true that patient responsibility can be checked on each carrier's website, we don't find this option practical because it's too time consuming.

Stay tuned for other ideas in our Payment Technology Series.