The recently updated US healthcare system has brought in fresh challenges for the patients and the healthcare providers alike. Several aspects of the reform in healthcare, like the value-based compensation models and the introduction of time-consuming medical billing rules and regulations, can cause loss of revenue collections for insurance providers across the US.
Failure to stay up to date on the various medical billing rules and regulations along with the medical billing errors can result in letting go of $125 billion uncollected revenue for the US healthcare providers each year.
Did you know?
As per the survey reports of Commonwealth, patients have experienced a 150% increase in the deductible costs, and only 62% of the adults are confident about affording their healthcare bills if needed. Apart from the increasing deductibles, the average out-of-pocket costs have also moderately increased to about 71% over the last 10 years. You will be amazed to know that a family typically spends $6015 out of pocket each year.
How to help your practice over the hurdle?
Although the above data pinpoint a miserable condition of the financial aspects of the healthcare domain, all is not lost. To mitigate the compliance risks and the financial issues faced, the medical practices ensure a more proactive approach towards their medical billing procedures. If you can prevent problems before they occur, it will only help you maximize your revenues.
1. Establish a clear collections process
You must have a proper collections process in place for your medical practice to ensure better financial conditions for your business. Establishing a step-by-step approach will streamline all the procedures involved. It can be great for improving the overall revenue cycles by informing the patients of their rights and responsibilities in time.
Though this is a detailed process and can be quite time-consuming, when you have a standard collections process in place, it can help you collect the reimbursements more quickly. You will be able to also identify when to send a bill for the collections and eliminate any gap in communications.
2. Manage all the claims properly
An overwhelming 80% of the medical bills contain some kind of error in them. And since the insurance companies are rather stringent about correct and accurate medical billing and coding practices, these erroneous bills usually get rejected. The cycle of submission and rejection, correction, and resubmission can take an unlimited number of weeks before getting cleared for the payments.
As a lot of time and effort goes wasted in correcting and resubmitting the claims, it is essential to ensure that they are accurate before submission. It involves scrutinizing all the information correctly before the final submission. Also, when you are resubmitting a rejected claim, go through the attached Explanation of Benefits (EOB) other than the common errors.
3. Minimize coding errors
The experienced medical coders use and describe the performed services using the standardized codes within a claim, thereby making it easier to process and decipher. These codes are used with various classification systems like ICD-10, CPT, or the HCPCS Level II.
While it provides a standard method for the procedures and descriptions, there is still a scope of errors. If a process description looks ambiguous or contradictory, get in touch with the insurance company to ensure the correct code. You can also check with the different medical coding resources to ensure the correct codes.
4. Prompt handling of the denied claims
Repeated checking for errors in the claim before final submission can minimize the rejections and denials. But in case of errors, you must handle them quickly and promptly. Get in touch with the insurance payers to clarify the problem and provide the correct information. This can expedite the claims submission process and minimize the resubmission process.
5. Find out ways to improve
If you want to maximize efficiency and revenue in your practice, you have to be updated with the regular changes that happen in the healthcare domain. Keep track of the performance and keep up on the latest healthcare regulations. Identify the problem areas and address them as soon as you spot them.
Enhance the accuracy and follow optimum efficiency by following the below-mentioned steps:
- Stay informed
- Track any pending accounts receivable
- Identify any problem accounts
6. Know when to outsource
As a medical practice, you must constantly bother about the patients and the latest trends in the medicine domain. You must also ensure excellent staff management. All your employees must know about the latest rules on medical coding standards, medical billing regulations, and changes in the insurance companies. With so many updates, there is always a chance for the tasks to slip off the cracks, which can result in rejections and denials. In fact, it can cost you time and money.
The best solution in such a scenario is to choose an outsourcing medical billing and coding company just like 24/7 Medical Billing Services if you want to cut down on your labor costs and keep on track with the multiple rules and regulations. These third-party specialists can effectively manage your revenues and bring back your financial condition to a better position.