Successful medical practices concentrate on quality of care, and the level of expertise of their practitioners. Billing is not typically a first consideration. Medical billing, however, fuels a health organization’s daily operations; therefore, warrants a better look and deeper dive.
What can practices do to minimize losses, ensure timely reimbursements, and collect payment? Here’s how you can ramp up your practice’s revenue with these front office billing tips.
Why efficient medical billing is critical…
It is impossible to sustain a medical practice without an efficient healthcare billing and collection process, even when you are a leading healthcare provider. Keeping a medical practice operational and profitable is impossible without revenue. Despite the need to focus on patients’ well-being and care, a medical practice must also pay the bills.
Billing, collections, and accounts receivable management are the lifeblood of a successful practice, and a healthy revenue cycle is imperative to sustain operational costs and receive payment for the services you provide. Healthcare professionals are often reimbursed weeks, or even months post patient interaction. Insurance claims are often denied, causing even more delay. Successful billing practices speed cash flow.
Medical billing and collections start before you see the patient…
When possible, patients should complete paperwork before check-in, via the web or by mail. A patient’s billing process begins with registration, a double check of insurance eligibility, and collection of the patient’s portion. This includes copayments, coinsurance, and deductibles. The billing and collections process may seem never ending, but by taking ownership of this part of your practice, you can ensure timely claims submission and payments.
Continue medical billing at check-out…
Physicians use procedures and diagnosis codes for each patient encounter. These billable codes are generated when practitioner notes are transcribed. Each claim’s ICD-10 and CPT codes are determined using this script. Charges should accompany each reimbursement code.
The medical coder verifies the correct code selection and adds appropriate modifiers to describe the treatment in greater detail. Educating physicians on coding nuances, and learning their practice intricacies, can streamline and optimize billing. Codified claims are entered into practice management software, scrubbed for accuracy, and uploaded to a clearinghouse submitted to insurers. The insurance company accepts or rejects the claim. Reimbursement amounts are determined through this process.
Payments are received from carriers, and any balances are transferred to secondary carriers or to pre-paid patients. Medical billers should handle all rejected, unpaid, or partially paid claims promptly to ensure payment. The goal of the claim submission and accounts receivable processes is to realize the shortest collection period possible and reduce the outstanding days from patient interaction to payment.
Assess your entire billing process and key indicators…
Examine the broader issues that impact your billing process. Practices often only look at overall payments or denied claims, rather than assessing how efficient their claims process is working. A medical practice’s success often depends on developing a well-organized revenue management plan.
Invest in staff training…
Implementing a standardized medical billing process requires trained employees. Front desk staff should be regularly reminded to confirm patient eligibility and benefits and collect patient balances at time of service. Create a flowchart of the exact billing steps. Clearly define the actions taken at each step of the billing cycle. Provide enough staff to do each job and train them well – shortcuts are rarely a good thing.
Pay attention to details when submitting claims…
Codes must always be exact, requirements must be met, or claims will not be paid. While HIPAA and ACA (Affordable Care Act) regulations have codified national standards for electronic healthcare transactions, millions of rules and edits must be considered when billing claims. The bounce back and forth of claims causes delays. Claims should be scrubbed regularly to identify your practice’s common billing code errors. The claim scrubber software is automated and typically available through medical software. These platforms can improve your first-pass claims acceptance rate.
Include the patient in the process…
Billing and collections can be improved by creating the highest quality patient experience. By establishing good relationships and communicating freely with patients, medical practices have a better chance of gathering accurate insurer information and helping patients understand their financial obligations.
Many patients do not regularly review their medical coverage plan, or understand their copays, deductibles, and out-of-pocket expenses. Medical practice staff try to explain fees and personal financial obligations, but since most patients are now shouldering more of the financial burden of their healthcare, it’s more crucial than ever to verify their insurance benefits and inform them of cost responsibilities. This should happen before services are rendered. In the event of a billing error, having clear information on hand creates transparency and trust between the medical practice staff and the patient. Maintaining a good rapport with patients is also beneficial when dealing with insurance company rejections. Insurance policyholders can often be effective advocates. Three-way calls can be useful and may result in a positive outcome.
Technology is tops…
Many healthcare practices rely on technology to streamline billing. Even in simple formats, digital technology offers patients multiple ways to pay using seamless digital transactions. Using advanced technology, and smart medical software, patients are connected to the various departments of a medical practice. This creates a more continuous flow of information between doctors, staff, and administrators.
Effective medical software systems automate numerous steps in the billing process, including suggesting medical codes, and checking medical claims against common insurance payer rules for reimbursement. By automating as many steps as possible within the practice’s clinical and administrative workflows, the provider can save staff hours, avoid unexpected denials, ineligibility, or larger-than-expected patient responsibility.
Know your carriers and contracts…
Maintaining consistent and open channels of communication with insurance carriers establishes the groundwork for straightforward resolution of claims issues. Maintaining a health plan contact responsible for resolving practice issues is beneficial and is a relationship that is worth developing. For resolution of payor interactions, continue up the command chain until payment is made.
Understand medical billing changes…
The pandemic has forever changed the healthcare landscape. Medical coding procedures have changed in response, particularly for telehealth. The Centers for Medicare and Medicaid Services (CMS) continue to implement changes that can be a challenge for many practices.
Outsource your billing…
Simplifying processes with SaaS platforms is the best billing tip. If you find your practice falling behind in billing and current regulations, you may want to consider outsourcing your billing to third-party specialists. Billing companies remain up-to-date on regulations and can help smaller practices ensure proper claims submission. Your staff is then able to focus more time on patient care. A medical billing management company can save practices time and resources by managing the most tedious of tasks, including following up with insurance payers on outstanding claims, or automating patient statements. When your practice is ready to outsource medical billing, Virtual OfficeWare Healthcare Solutions is a trusted leader in medical billing solutions that helps healthcare practices deliver the most effective outcomes. They will tailor billing services to suit your organization’s needs.
Lost revenue is not automatic, but solutions can be…
Denials are often the result of human error. When a practice must resubmit denied claims, it costs an additional $25 to $45 per claim on average. As a result, many practices simply write off underpaid or denied dollars, resulting in significant revenue losses for a practice. Contact Virtual OfficeWare (VOW) if you need help working claim denials. We have dedicated staff to review rejected or denied claims, identify the reason(s) for rejection, and help resolve the issue to ensure timely, and proper, reimbursement. VOW automates your billing processes, increases revenue, and allows you to focus on what you do best – helping your patients.