Payer Tracking – The First Step to Successful RCM and How to do it Well

Quality Healthcare Resources
March 22, 2022
May 5, 2023
Polaris Group Profile
Polaris Group
May 5, 2023

Discover key tips to elevate your Payer Tracking system in our newest blog post.

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Payer tracking is an important part of every skilled nursing facility’s billing and revenue cycle management strategy. However, it can be hard to manage without the right processes and tools in place. Here’s how you can turn payer tracking from “just another task” into a helpful tool that increases collections, decreases denials, and protects your bottom line.

What is Payer Tracking?

Payer Tracking is continuously monitoring a resident’s payer coverage throughout their care at your facility. It starts with verifying insurance authorizations prior to admission, and it continues as a resident’s care plan and projected time at your facility develops.

Why is Payer Tracking important?

You need verified and reliable payer sources to bill and collect from when it’s time to bill for care. If a Medicare admission exhausts their benefits, do they have a payer in place after their last Medicare-covered day? If a resident plans to pay themselves, do they have the economic resources and will they need a Medicaid Application? Tracking a resident’s payers and planning for coverage will help you and your residents.

Here are a few tips to make Payer Tracking a straightforward but comprehensive process:

Start off with a patient intake form 

Patient Intake questions are questions that help verify payer coverage for new patients. They help you make a more informed decision for who to admit. Examples of patient intake questions include, “Can you please verify the resident’s citizenship?” and “Can you confirm the resident’s income sources and monthly income?”  These questions give you a more complete picture of a resident’s coverage, as well as how they’ll work with you when it comes to payment. If a resident or family struggles to answer these questions or resists, it might signal billing and collection challenges down the road. Here are some of the patient intake questions QHCR recommends.

Stay organized with a centralized tracking tool

Your residents’ payer information should live in a centralized location. Whether that’s an Excel spreadsheet or some other tool is up to you! A comprehensive spreadsheet should include categories like Insurance, Medicare and Medicaid status, and progress along the billing cycle. Set reminders or note dates when you should double-check a resident’s projected discharge date, Medicaid application status, or other coverage inflection points. Investing a little time in creating an easy-to-use tracking tool will help you spot and avoid coverage and billing issues down the road.

Make sure collection goes hand in hand with tracking 

In addition to updating the payer status of each of your patients, it’s also important to work together with the biller on the collection status for each patient. Understanding who to bill and when, and the progress of collection is crucial to avoiding and resolving billing issues.


What’s next: elevating your Payer Tracking

Once you feel comfortable with the basics of Payer Tracking, you can move your community towards automating processes and adding more nuanced categorizations and tracking statuses. QHCR employs dedicated Payer Trackers and uses more sophisticated systems. Contact us here if you’d like support.

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