To mitigate financial issues and compliance risks, medical practices are taking a proactive approach to their billing process. By preventing problems before happening, healthcare practices can maximize revenue, ensure proper reimbursement and continue to provide better healthcare to the community. Here we have mentioned few steps to be more proactive in medical billing procedures:
1. Patients should be reminded of the collection process clearly
Providers need to follow few steps to ensure the financial health of their practice. A step-by-step approach clarifies procedures; improves the revenue cycle as patients are well informed about the terms. Here are the steps that need to follow:
- Clearly state the terms of agreement and what you are expecting from the patients while it comes to pay the debts. Remind them of their obligations so that they can’t claim ignorance as a reason for delinquency.
- Collect as much information as possible about the patient at their first visit. Ask for photo id, address, email, phone number, workplace etc.
- Check with patients regularly if they have changed their addresses to stay updated and ignore sending mails to wrong addresses.
- Include agreement for allowing messages to be left in their voicemail about billing matters.
- Remind patients about co-pay and its importance with trained staff so that patient’s queries can be answered.
- Retrieve insurance cards and verify patient eligibility to avoid claim denials.
- Avoid the paperwork by collecting co-pays and balances up front on the basis of their deductibles.
- Patients should be informed immediately about the payment available options like credit cards, checks or cash payments for faster payment.
- A letter should be followed subsequently to the patients when the billing gets, due, overdue or about to be sent as a physical letter carries more physiological weight than a voicemail message.
2. Claims should be managed properly
Maximum medical bills contain errors and get rejected subsequently. The cycle of claiming gets delayed for submitting, rejecting, editing, and resubmitting. Therefore, companies should follow the step-by-step process to ignore claim rejection. Because of the wasted time and effort involved in editing and resubmitting claims, claims must be accurate and complete the first time.
- Avoid poor documentation to ignore claim rejection. In any case of wrong documentation the biller should contact the provider immediately.
- Denied claims should not be allowed any EOB (Explanation of Benefits) as it is difficult to identify and correct the mistake.
- Many insurers allow online submission of appeals and corrected claims. In that case, instead of an EOB claims should be returned with claim number and denial codes to identify errors.
- Double check claims before submitting and communicate for rendering inconsistency in information. Follow-up with insurance representative and the insurance company is important to keep them updated.
- Try to attach the EOB or denial codes while resubmitting denied claims. Also, ask the insurance company if they can clarify the portions which are problematic.
3. Try to minimize coding errors
To make the claims easier to decipher and process medical coders should describe the procedures standardized codes. The codes should also use ICD-10-CM, CPT, and HCPCS Level II classification systems. Medical coders must avoid some common mistakes while including the codes. The common mistakes are:
- One of the most common issues in medical coding is insufficient diagnosis codes. The diagnosis documentation is much straightened about the requirements. By improving quality initial data collection this can be avoided easily.
- Incorrect modifier usage is another mistake for lost reimbursement in medical billing practices. In these cases, wrong modifier gets attached to the claims causing half or reduced reimbursement or denial of claims. The wrong modifiers like over coding and under coding can be accidental or intentional. So, double check codes before submitting.
4. Always try to improve the ways
Healthcare is ever-changing and it is immensely competitive. So, to stay ahead in the race tracking the performance, maximizing efficiency, and staying updated with the latest healthcare regulations is important. To ensure optimum efficiency these steps should be followed:
- To determine effective collection procedure tracking the pending collection in every quarter is very important.
- Staying updated with ever-changing medical billing rules and training the staff about the recent billing and coding protocols reduces repeated resubmission of claims.
- Implementing ways to track problematic behaviors like regular declined payments, late payments or frequent changes in contact information and outsourcing the medical billing process to third-party personnel can increase profitability.
Implementing a proactive billing process pays off with increased cash flow, efficient office operations and finally improves the overall experience for patients. At 24/7 Medical Billing Services, we know the intricacies of the revenue cycle management for specialty hospital-based practices. Our team consists of dedicated specialists who pay minute attention to the billing process, claims to file, and follow-ups to lessen the in-house burden. So, if your healthcare practice is strained from delinquent accounts and overloaded with pending and rejected claims, contact us to get the benefits of improved collections.