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Medical Billing and Collection Tips From the Pros

Medical Billing and Collection Tips From the Pros

Medical billing is complicated, but these tips from healthcare professionals can help.

  • To fully familiarize yourself with the medical billing process, have a broad view of your needs and train your staff.
  • Medical billing experts also suggest involving the patient, taking a detail-oriented approach, and using technology.
  • You should also be aware of your payers and the changes the coronavirus pandemic has brought when you consider third-party medical billing services.
  • This article is aimed at doctors and practice owners who want to simplify the medical billing process.– When we visualize a successful medical practice, we can think about the quality of care and experience levels of doctors. Billing isn’t an aspect of the business that usually comes to mind. However, for medical practices, there are few parts of the more crucial operations than billing.

“Without revenue, a doctor’s office cannot make a profit and remain operational,” said Andria Jacobs, chief operating officer of PCG Software and registered nurse. “A doctor’s office, although it focuses on patient wellbeing and care, is a business and it has to be profitable. Invoicing, collections and credit management are the lifeblood of a successful practice. ”

A healthy revenue cycle is key to supporting the costly work of providing health care, but it’s not always easy to make sure your study gets paid for the services you’ve provided. It can be particularly difficult because healthcare professionals are often reimbursed by third-party payers after the patient has already come and gone and there is a delay between providing the services and receiving the payment.

Additionally, insurance claims can be refused or denied for various reasons. Human error plays a significant role in many of these denials, with up to 75% of claims coded incorrectly.

“Each denial of a claim will cost the practice $ 25 to $ 45 to re-bill and collect,” Jacobs said. “Many practices simply write off underpaid or denied dollars, costing the practice a loss of revenue in an institutionalized way.”

What are the best ways your firm can minimize losses and ensure full and timely payment for the work you have already done?

1. Understand the billing process.

You may feel overwhelmed and even a little intimidated by the billing and takings. However, it is important to start with an understanding of the process, even if someone else is ultimately responsible for the day-to-day matters. By taking ownership of this part of your business, you can ensure timely filing of complaints and prevent fraudulent activity.

How the medical billing process begins

According to Nancy Rowe, owner and operator of Practice Provider Corp., the billing process begins with patient registration, verification of insurance eligibility, and collection of the patient’s fee (copayments, coinsurance, and deductibles) at the time of paying for the service. .

Doctors provide programmers with the procedure and diagnostic codes for each patient visit. These codes come from the doctor’s notes, diligently taken during the meeting with the patient in question. Doctors then convert these notes into a formal medical script. This script is what programmers use to determine the appropriate ICD-10 and CPT codes. Each code must be charged so that the payer knows the amount to be refunded.

“The programmers verify the selection of the appropriate code and add the appropriate modifiers to better describe the treatment,” Rowe said. “Spending time with doctors to learn how they exercise and then educating them on the nuances of coding helps simplify and streamline billing.”

How the medical billing process continues

The coded claims are then fed into the firm’s management software, cleaned to be exact, uploaded to a clearinghouse and sent to individual insurance carriers. Insurers accept the payment request or reject it. You can track all complaints about your practice as they move through the payer adjudication process. Through this process, payers decide how much money, if any, to pay you back.

Payments are received by insurance companies and balances are transferred to a secondary insurance company or to the patient. All denied, unpaid, or partially paid claims must be handled immediately by a medical biller to secure payment.

“The overall goal of the complaints and debt management process is to achieve the shortest possible collection period,” said Jacobs. “Minimizing payment days … promotes a clear revenue stream.”

2. Look at the big picture.

Once you understand how billing works, it’s time to look at the more general issues that can affect your billing process and identify the best approach for your practice.

“Many practices often only look at overall payments or the number of denied requests, but they don’t dig deep to gauge how efficient and effective their billing process is,” said Erica Woodward Strick, director of RCM operations at Modernizing Medicine. “Conducting an in-depth analysis of billing KPIs, comparing industry standards, and creating a revenue management strategy are essential to the long-term success of a practice.”

Looking at the big picture includes keeping abreast of industry and regulatory trends and understanding how they can affect the health of your medical practice’s revenue cycle, Strick added.

3. Invest in staff training.

Once a standardized and measurable billing process has been created, properly trained staff members are needed to implement it. It is never wise to skimp on this step or assume that only the staff member making the requests needs training. “A healthy revenue cycle begins with well-trained front desk staff who have the tools in place to verify patient eligibility and benefits and the ability to collect patient balances at the time of service,” Rowe said.

Creating a flowchart of the exact steps for billing and receipts is also helpful, according to Craig Ferreira, president and CEO of Survival Strategies.

“It clearly outlines the actions that are taken at each stage of the flowchart,” said Ferreira. “Get enough people to do each job and train, train, train”.

4. Pay attention to details when filing complaints.

Complaints not sent correctly will not be paid, so take the time to ensure that all codes are correct and that all requirements have been met.

“Although HIPAA and ACA regulations have codified the adoption of national standards for eHealth transactions, code sets and unique health identifiers, there are still millions of rules and changes that need to be considered when billing each line of health. request, “said Jacobs.

“It goes without saying that comprehensive information is essential,” said Cindy Ehnes, executive vice president of COPE Health Solutions. “Sending a request to the correct payer is critical, although in a delegated payment environment it can be difficult to know which payer, risk medical group or health plan is responsible for the payment. This can lead to delays such as pinging requests. of compensation pong. ” “. back and forth.”

Regular cleaning of complaints, which involves identifying and correcting billing code errors, is also critical, said Stephen Dart, vice president of engineering at AdvancedMD. “The process results in cleaner complaints, less waste and better communication with the payer,” said Dart. “By doing right from the start and allowing more types of changes to the claim before it is sent to suppliers, [one practice] will be more efficient and successful with reimbursement.”

The claims settlement process is automated and is generally available through the billing portion of the medical software. Check out our reviews of the best medical billing service providers to find out how these options can improve the acceptance rate of first-step claims. You can also read about one of the best solutions in our AdvancedMD review.

5. Include the patient in the process.

Creating the best possible patient experience can have a positive impact on the billing and collection process. Medical practices that build strong relationships and create open lines of communication with patients have a better chance of gathering accurate information from the insurer and making patients understand their financial responsibilities.

“Many patients and their families never review coverage evidence and don’t understand the financial implications of copays and insurance terms like ‘deductible’ or ‘full pocket costs,'” Jacobs said.

As a result, it is often up to the doctor’s office staff to clearly explain personal financial obligations and expenses. With patients bearing the financial burden of their health care the most, it is more important than ever to check insurance benefits and provide information on costs before any services are provided.

“Having this information upfront creates transparency and trust between the practice staff and the patient, which can help avoid costly billing errors later on,” Strick explained.

It is also important to have a good relationship with patients when it comes to insurance company rejections and waste follow-up.

“Sometimes the best defender is the partner or contractor,” said Sunni Patterson, president of RMK Holdings Inc. “Three-way calls are usually successful and very effective.”

6. Use technology to its full potential.

Technology can play a central role in streamlining the billing process. At its most basic, technology can offer patients multiple ways to pay through seamless digital transactions. The latest technology, such as advanced medical software, can connect the various departments of a doctor’s office and create a smoother flow of information between doctors, staff and administrators.

“Some medical software systems can also help automate steps in the billing process, such as suggesting medical codes and checking medical claims against common insurance payer rules for reimbursement,” Strick said.

“By automating as many steps as possible within the practice’s integrated clinical and administrative workflows, the provider will save staff hours and avoid unwanted surprises in the form of rejection, ineligibility, or greater than expected patient liability,” he added. she.

Dart noted that this includes the use of electronic health records, the automation of health plan and demographic checks, the use of complaint cleaning technologies, and the incorporation of self-service applications for patients, as a feature. of the portal, electronic declarations, digital communication, access points and integrated payments by credit card. .

7. Know your carriers and their contracts even better.

By maintaining consistent and open communication channels with patient insurance companies, you are laying the groundwork for easy resolution of problems when they arise.

“Having a health plan contact responsible for solving practice problems is very helpful and pays for developing a caring and collegial relationship,” Jacobs said.

Jacobs also advises a firm’s management team to regularly review charges, payments and collections for its top 10 carriers. “These are the contracts that generate the most revenue and any problem has the greatest influence on overall revenue.”

By staying abreast of the latest health care laws, federal and state regulations, and insurance contracts, you also position yourself to defend your practice and your patients in the face of denial.

“Take off those pink glasses and realize what you’re dealing with,” Ferreira said. “Know your contracts and respect your payers. When you talk to insurance companies, get a reference number for the phone call. Don’t be afraid to step up the chain of command.”

8. Understand how the coronavirus pandemic has changed medical billing.

The coronavirus pandemic is formally classified as a national emergency, so medical coding procedures have changed in response. The Centers for Medicare & Medicaid Services (CMS) has implemented these changes:

  • Telehealth healthcare – with no geographical or location-based limits – will be offered to patients.
  • Telehealth services will be reimbursed by Medicare at the same rates as in-person patient encounters. This rule applies for visits pertaining to COVID-19 and other conditions, and across state lines if the services adhere to local state laws.
  • Telehealth healthcare can now report more services.
  • Telehealth E/M office and other outpatient visits can now be reported based on time or medical decision-making (MDM).
  • New CMS telehealth codes have been added.
  • Eligibility for telehealth is offered to a greater number of qualified healthcare professionals.
  • New and existing patients can seek telehealth services.
  • Physician visits via telehealth are eligible for reduced or waived cost sharing.
  • Medicare beneficiaries are eligible for free COVID-19 testing and related visits if physicians use the modifier “CS” in their claims.

9. Consider using a reputable billing company.

If you find yourself late in billing or not compliant with applicable regulations, you may want to consider outsourcing all or part of your billing to outside specialists.

“I recommend using a billing company with size and weight that is willing to be a ‘squeaky wheel’ that gives you the fat and the money,” Ehnes said. “Find a company that is a true advocate for those who truly care for patients.”

Medical billing companies are up to date with billing regulations and can be an ideal resource for smaller practices to ensure proper filing of complaints. Plus, they allow your staff to focus on the work that is more central to their core mission. Check out some of our top picks in our athenahealth review and Kareo review.

“By offloading some of the tedious tasks, like tracking insurance payers on pending claims or printing and mailing patient statements, to a company that specializes in medical billing practices can save staff time and resources,” said Strick.

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