Efficient billing and collection strategies can improve clinical, financial, and operation outcomes for healthcare facilities. Modern healthcare providers can leverage sophisticated software and outsourced services to improve medical coding and billing accuracy and efficiency. Learning the billing flow from start to finish also makes it easier to use existing solutions. Here are five tips for efficient medical billing:
1. Establish a Collection Process
Healthcare providers need a clear, step-by-step collection process to maintain the financial health of their practice. A clear procedure improves the revenue cycle and keeps patients informed of their responsibilities. You should establish a clear procedure, collect and verify patient information and get permission to receive messages. Remind patients about pending payments and verify eligibility regularly. You should also collect due balances upfront.
Patients should be aware of the payment options. Write out letter sequences to remind patients of coming payments, overdue balances, and collections. You should customize the collection process to your practice. Some specialties, like radiology, require a different approach and tweaks. Implementing a standard process can speed up collections and eliminate communication gaps and notification delays.
2. Set Clear Payment Terms
Patients should understand the payment terms and what they owe the business. If insurance covers the bill with a specified co-pay, you should inform the patient about their bill and how to pay. Patents may not know how much their co-pay will be, so you should tell them during check-in. Request the payment while the patient is still at the facility. If they can’t afford the co-pay, keep in touch through effective patient communication workflow.
Send patient statements and reminders on time and figure out what to do concerning non-paying patients. The claim sent to patients should include the parts the insurer covered and declined to pay. Working with a reputable medical billing and coding company can help you establish clear payment terms and schedules. Leveraging pro help reduces coding errors, improves accountability, and simplifies claims management.
3. Pay Close Attention to Detail
If you don’t fill the claims properly, you won’t get paid, so attention to detail is invaluable. A missing or misplaced letter in the patient’s name invalidates the claim. Errors are common in medical coding and billing, but you can reduce them with technology. Watch out for incorrect patient information, including name, DOB, insurance ID, provider information, address, name, and contact. The goal is to avoid incorrect entries and duplicate billing.
Reputable billing companies use sophisticated software to double-check all details before submission. Working with experienced billing companies can prevent basic mistakes like poor documentation and forgetting EOBs on claims. Medical billers will also take care of missing and unclear denial codes and claim number references. The biller will also follow up with insurance company representatives to fix errors as soon as they’re identified.
4. Minimize Coding and Billing Errors
Medical coders need to describe all performed procedures using standard codes. Using proper coding makes claims easier to process and decipher. Codes use different classification systems, including ICD-10-CM, HCPCS Level II, and CPT. Even with standard systems, errors still occur due to incorrect, mismatched, and missing codes. Experienced medical coders can catch such errors before they become an issue. Other errors can be harder to detect.
Non-specific codes and incorrect modifiers are common errors that can prevent healthcare providers from getting reimbursed for their services. ICD-10 requirements are more detailed than the ICD-9, so healthcare providers may face insufficient diagnosis codes. Upcoding and under-coding are also popular and can result in miscommunication with the insurance provider. Experienced coders can help you work with the latest coding resources to avoid errors.
5. Handle Denied/Rejected Claims Promptly
A denied claim refers to any bill the insurance company has processed and deemed unpayable. Insurance providers can deny claims due to violations of the payer-patient contract or post-processing errors. The company will return the claim to the biller, explaining the reason for the denial. A rejected claim isn’t processed due to errors. You can appeal, correct, and resubmit rejected claims, but the process is costly and time-consuming.
Checking for errors before a submission is the best way to prevent rejection. If errors occur, handle them promptly and keep in touch with the payer’s representative. Denied claims are much harder to deal with. You’ll need to get the payment from the patient, who may not be ready to cover the cost of the service. An experienced medical biller can help you identify the best ways to recoup payments for denied and rejected claims.
Working With a Medical Billing Company
The best way to handle medical billing is through experienced revenue cycle management companies. Professional medical billers have the skills and experience to streamline the coding, billing, and collection process. Stick to long-serving billing companies with a clean track record for helping similar organizations and leveraging modern technology.