Year after year, regulatory changes make medical billing more difficult. If you handle your billing in-house, the chances are good that your staff members spend a significant amount of time trying to understand compliance requirements, coding changes, and reasons for denials. Perhaps they’ve adapted the billing process and got things back on track only to face new changes and regulations. Outsourcing your medical billing means having experts on-hand who stay in front of regulatory and coding changes, but even if you choose to keep your billing in-house, you must have these three tools to be successful.

1. Effective Denial Management

Every single healthcare practice sees denied claims – it’s part of life when it comes to medical billing. But it shouldn’t be a big part. Correcting and resubmitting claims is one aspect of the denial management process but don’t be fooled into thinking it’s the most important one. Without key insights, your billing department is playing a game of pin the tail on the donkey – turning in circles while blindfolded, hoping to land on the mark. And while they might hit the target every now and then, it makes more sense to remove the blindfold. For effective denial management, that means measuring the amount of denied claims, identifying reasons for the denials, creating a measurable long-term plan for reducing claims denials, and finally, tracking performance to ensure you’ve met your goals.

2. Effective Reporting

A critical component to denial management is effective reporting. Without relevant data, analysis, and reporting, you simply can’t manage denials. But reporting extends to other areas as well. You need a clear, comprehensive view of your entire practice so you can take steps to improve your performance. And you need that data to be reported in a timely manner because it doesn’t do any good to see outdated performance measures. Important reports that could improve key areas of your practice include provider productivity, front desk employee effectiveness, coding profiles, referring physician profitability, and payer contractual compliance.

3. Compliance Charting and Coding

Finally, mistakes in medical billing can lead to audits which can lead to steep fines or even worse—conviction for fraud. Your compliance program for charting and coding should be one of the key components in your company’s medical billing process, and it’s important that your staff be properly trained and receive continuing education in compliance requirement. If your practice does not have an active compliance plan, this should be your first concern. A comprehensive compliance plan will include meeting all federal regulations as well as improving coding, charting, and documentation processes.

Whether you manage your billing in-house or you outsource your medical billing, you need the best tools to improve performance and increase profitability. Medcare MSO provides denial management, effective reporting, and comprehensive compliance plans to ensure accurate coding and charting. We offer customized insurance and patient billing services that keep you compliant, and we create detailed reports, so you always know where you stand. With Medcare MSO, you can stop worrying about your bottom line and just focus on providing quality care.

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