Mastering Medical Billing: 7 Essential Tips for Optimal Efficiency in Healthcare Practices

Comprehensively reviewing financials and revenue cycle is necessary for hospital institutions for developing corrective measures at the appropriate time. This article is emphasized in acknowledging healthcare institutions of medical billing techniques they should install for assisting their medical practice. Health care providers should periodically review their financials and revenue cycle for corrective measures as per their requirements. Medical offices/Healthcare institutions should realize they should improve their medical billing operations for the best results. Improving provider’s efficiency and efficacy rates, these latest billing techniques will help businesses in coping up with the exponential rise in medical costs over these past few years. Enabling patients to experience a transparent relation between healthcare providers, these encourage patients with diverse options for making payments.

Thus, medical service providers should consider a wide array of factors while committing to billing operations.

Following are some processes that can smooth medical billing processes:

1. Development of a Clear Collection Process

Healthcare providers should have an extensive collection process for ensuring the financial health of business practices. With step-by-step approaches make it possible for thorough clarification of all involved procedures. This can also improve revenue cycles for properly ensuring patients thoroughly acknowledge their responsibilities.

The collections processes must involve the following steps:

  1. Establishment of clear terms:

Hospital institutions should inform patients of their expectations for payment of their debts. They should also be informed about their responsibility for paying as part of their updated patient paperwork and periodically remind them of their responsibility especially during transition. This ensures claim ignorance as an effective reason for delinquency. This proves to be challenging for medical practices with meager face-time between patients and practitioners, such as radiology practices, which gives more space for patient misunderstandings.

  1. Collection of patient information

Retrieving extensive information of patients, ranging from address, phone number, email, workplace, etc, Hospital Institutions should also ensure keeping photo IDs after each patient’s first visit. It is also crucial for sending billing requirements for sending to a collection agency down the line.

  1. Verification of patient address

Verifying patients regularly will ensure any changes in their address or contact information. This step is critical as it enables reaching patients without wasting time and money.

  1. Permission for leaving messages:

Healthcare institutions should draw out agreements within new-patient paperwork for allowing messages related to billing to be left on their voicemail.

  1. Reminding patients about co-pays:

During communication with patients, they should be updated about their co-pay and its importance. Ample interest should be given for training staff for this as well as answering any questions a patient might have.

  1. Verify eligibility regularly:

Healthcare institutions should drive retrieval of insurance card and verification of patient eligibility alongside every visit for avoiding claim denials. The usage of an automated verification system also ensures saving on labor costs.

  1. Collect up-front:

Collection of co-pays and balances due based on their deductibles upfront for eliminating the paperwork and labor.

  1. Payment options:

Faster establishment of payment options to the patient and being clear cut about what these payments should cover, as well as the availability of payment plans.

  1. Letters:

Hospital institutions should generation of letters for sending out to patients whenever their bill is due, overdue, or about to be sent to collections. Clients give more importance to the physical letter as they carry more psychological weight than a voicemail message. Some specialties may have to change certain parts of this process for suiting better for these businesses. This is mainly because they’re less likely for meeting patients face-to-face for discussing billing responsibilities. Such cases should follow procedures for focusing extensively on new-patient orientation, validation, and notification rather than discussion. This detailed and time-consuming process should be initiated by the implementation of a standard collections process for helping healthcare providers in the collection of reimbursement. Effectively identify when to send bills to collections and eliminate lack of communication or knowledge for patient delinquency.

2. Minimize Coding Errors

In medical claims, medical coders should know how to describe the performed procedures with the assistance of standardized codes. This will make the claims much easier to decipher and process. Using ICD-10-CM, CPT, and HCPCS Level II classification systems can be useful. Providing a standardized method of describing procedures, there are still chances for errors such as incorrect, mismatched, or missing codes. These kinds of errors are often caught by clearinghouses much before they end as issues. The common errors as follows:

  1. Non-specific diagnosis codes

Diagnosis documentation requires to be parallel with ICD-10 regulations. These stringent requirements are common issues in medical coding which have insufficient diagnosis codes. This comprises collecting newer information about the patient’s condition that the practitioners have never documented before including updates on their health condition. This can be solved with the improvement of the quality of initial data that is collected about the patient from the referring physician.

  1. Incorrect modifiers

The use of incorrect modifiers leads to a loss in reimbursement in radiology practices. In case of wrong modifiers adding to a claim or missing of required modifier from claim lead to complications. These modifiers depend solely on the requirements of the payer. These are the most frequent sources of coding errors even if it is prompt for potential problematic errors such as up-coding and under coding, which are intentional or accidental.

  1. Up-coding: Addition or exchange of certain codes with the codes is far more expensive procedures which lead to the result of miscommunication between the coder and the provider, which is illegal.
  2. Under coding: Omission or exchange of certain codes with the codes are less expensive and happens as the result of miscommunication between the coder and the provider. This can happen whenever the provider intentionally leaves out or corrects a procedure from the bill.

Hospital Institutions should double-check codes much before claim submission. In the case of contradictory or ambiguous procedure descriptions, health institutions should contact the service provider much before assigning the code for avoiding up-coding or under coding. If any doubt persists, they should cross-check with appropriate medical coding resources for ensuring the correct code is being used.

3. Prompt Handling of Denied or Rejected Claims

Hospital institutions should know ample differences between a rejected claim and a denied claim. Rejected claims are one anything earlier to processing and yet to be discovered of one or more errors preventing insurance companies from paying the bill as soon it’s written. Denied claims are claims that should be processed and must have a deemed un-payable for discovered violation of the payer-patient contract, presence of vital errors caught after processing. In both cases, the clients will have to return the claim to billers explaining the problem. Rejected claims are apt for correction and resubmission, but denied claims should be appealed much before resubmission, and is a costly and time-consuming process.

Revising for errors in claims minimizes the occurrence of rejections and denials. These errors should be handled as quickly as possible.

Communicating with clients/insurance companies will help in clarification of problems with the original claim and provide information over current claims during processing. This helps expedition of the claim editing process and minimizing of appeal and resubmission times.

4. Proper Management of Claims

Most of the medical claims come with errors and even though insurance companies have apt for medical billing and coding practices, their medical claims are likely to be rejected. The total cycle of submission, rejection, editing, and resubmission often takes much time resulting in making providers wait for months before receiving payments. Editing and resubmission of claims require wasted time and effort but it is critical for making the claims accurate and complete. For this, the information should be correct and double-checked for possible errors much before submitting them.

Common errors involve:

  1. Incorrect patient information involving the Name, date of birth, insurance ID number, etc.
  2. Incorrect provider information comprising Address, name, contact information, etc.
  3. Incorrect insurance information ranging from Policy number, address to electronic payer ID
  4. Failure for verification of services to be reported or reimbursed leading to duplicated billing
  5. Poor documentation with incorrect, illegible, or incomplete documentation of a procedure or visit. This increases the difficultly for verification and completion of the claim making the billers to contact the provider for more information.
  6. Not attaching the Explanation of benefits for denial of claims, making it more difficult for identifying and correcting the error.
  7. Unclear denial codes or claim number references on denied claims.

For minimizing billing problems, healthcare institutions should double-check claims much before submitting them and communicate with providers for checking inconsistency, incompleteness, or unclear.

After submission of medical claims, health institutions should check the proceedings of the insurance company and keep up-to-date on any errors to encounter. While resubmitting denied claims healthcare businesses should review the Explanation of Benefits (EOB) that is attached to it. When the insurance companies return medical claims without an EOB or denial code attached, healthcare institutions should contact them for clarification of any problems.

5. Automation

Healthcare providers should choose automation for minimizing costs and adding up convenience for the patient. An automated billing system minimizes effort, saves time, and eliminates human errors. This also makes the patient have an easy understanding of their billing operations. Automation also benefits Health care provider staffs and their patients as this make medical billing protocol streamlined and automated.

6. Using of EHR for Payment Incentive under MIPS

Medicare system of payment adjustment makes hospital institutions for payment bonuses, payment penalties, or no adjustment of payment under the Merit-based Incentive Payment System (MIPS) program. Enabling Healthcare providers to choose from varied methods of reporting to MIPS, in which Electronic Health Records (EHR) is the most popular. With comprehensive medical information of the patient’s in digital format, EHR gives deep analytics information and are designed for submission to MIPS. Health care providers should compare all options carefully before choosing the most suitable option as per their requirements.

7. Use of Improved Artificial Intelligence

Artificial Intelligence (AI) technology is extensively used for the development of a series of applications. In the healthcare industry, the use of AI is extremely useful and comes in handy for coding and billing applications. AI can also be used effectively for the extraction of specific data patterns & sets and collecting patient payments.

Medical providers if choosing to perform in-house medical billing, they will have to choose a series of challenges ranging from building and maintenance of workforce and technology to complying with government regulations. Billing operations are extremely labor-intensive, yet a critical part of their business model and revenue cycle. It demands vast experience and skill just like our experts possess at OURS GLOBAL for handling such operations. Our well qualified medical billing experts ensure billing accuracy and speed.

With an efficient billing and credentialing company, we focus on providing the best-in-class service possible while assuring honesty, transparency, and tenacity. Contact us right away to benefit from our unique and worthwhile medical billing services.