What Are the Best Ways to Optimize Medical Billing?

Medical billing services can be time-consuming and monotonous, and can take the employee’s focus from the job, resulting in mistakes and pending payments, rejected claims, and a wobbly revenue cycle. Therefore, it is very important for healthcare providers to optimize their medical billing process so that their revenue inflow is always in the pink of health.

Some of the best ways of optimizing include:

1. Collections Process

You need a clear, well-defined process to improve revenue cycles.

• Educate patients properly regarding their financial obligations so they cannot claim ignorance later
• Gather detailed patient information like contact details, photo ID, and so on
• Verify the address, and ensure it is current, so that bills reach the patients in time
• Ask for permission to leave billing related messages on their voicemail
• Remind patients regarding their co-pays
• Check the insurance card and make sure the patient is eligible for insurance on every visit so that claims are not denied; you can also use an automated system
• Collect all dues from the patient upfront so that you don’t have to spend resources following up later
• Inform patients about payment options – credit cards, checks, cash, or payment plans
• Send a series of letters to remind patients about due and overdue payments, and when a collection agency is being called
• Specialties that see patients upfront less may need to have alternative steps or more communication with patients

Though this takes some effort, its critical to implement a standard procedure so that everything goes smoothly later.

2. Handle Claims Properly

Medical billing services staff agree that many bills contain mistakes because of which they are denied. The entire process of submitting, denying, modifying and re-submitting claims can take several weeks, and providers have to wait for ages before they receive payment. It is vital that the claims submitted are complete and precise the first time; which means that correct information must be entered, and double-checked to rule out mistakes at submission.

These mistakes are very common, and medical billing services staff should be the most careful:

• Mistakes in patient details
• Erroneous provider information
• Wrong insurance details
• Billing a service more than once
• Incomplete, incorrect or illegible documentation regarding patient visit or treatment, causing verification difficulties
• Failure to attach ‘Explanation of Benefits’ to a rejected claim (resubmission)
• Missing or incorrect claim reference number or denial codes

All claims should be double checked before submission and followed up with the insurance payer. In case of inconsistent or unclear information, communicate with the provider to get a clear picture.

3. Reduce Coding Errors to Zero

Medical coders have to translate diagnoses, procedures and rendered services into ICD-10 codes; these ICD-10 codes are used by medical billing services to enter the appropriate charges. Sometimes, coders may assign the wrong codes, or omit some new information etc. Sometimes, the code used may be for a more expensive procedure, or a less expensive procedure. Either way, the amount billed is usually wrong. A system must be developed to ensure no coding escapes the noose.

4. Handle Rejected or Denied Claims

Claims get rejected or denied because of a variety of reasons. In both cases, the claim is returned to the healthcare provider with an explanation. A rejected claim can be resubmitted after correction, but you need to appeal a denied claim – this process costs more time and money. To avoid such situation, it is mandatory to have in place a process that scrutinizes the claim to minimize the possibility or rejection or denial. If denied it should be handled by the claims denial department altogether.

Optimizing the claims process should be a continuous process. There has to be proper controls and audits in place to keep a track on how every bill is generated and submitted.