2022 CPT code updates

There’s no question that submitting claims is a primary function of medical billing, but if you leave it at that, you will lose a lot of potential income. There is more to the claim submission process in medical billing than just filling out a form and sending it in, and the additional steps are things that a medical billing company can do for you.

Claims Must be Scrubbed Before Submission

Even if you are doing your own claims instead of contracting with a billing company, “scrubbing” medical claims should be part of the process. An experienced biller should be reviewing all claims after the coder enters the information.
They need to check informational details like verifying correct dates, ensuring patient name matches their medical record exactly, etc. Scrubbing should also include confirming that all necessary subcategories and modifiers are included with the correct codes. This additional step will improve your first-pass resolution rate significantly since minor errors on claims account for a large percentage of rejections.

All Rejections and Denials Should Be Managed

Reworking claims that are denied or even rejected without being processed due to missing or incorrect data can be time-consuming—however, dropping these claims has resulted in billions in revenue being lost. Medcare MSO excels at reworking claims because we have developed a system that allows our billers to quickly determine what the problem is and get it corrected.
Any medical billing company that is handling your claims should be prepared to deal with all claims that do not get paid and keep track of them until they are resolved. It takes skill to do so effectively, so that the process doesn’t cost more than the value of the claim, but having an efficient system and trained staff makes it possible.

Accounts Receivable Should Not Be Abandoned

Another area where huge losses of potential revenue occur is old accounts receivable, or old AR. The longer a bill goes unpaid, the less likely it is to get paid, but that doesn’t mean you should give up. Often, the reason patients don’t pay their bills is because they don’t understand what they are being charged for. Or they may not know why their insurance didn’t pay it.
A medical practice management system should include a process for tracking old AR accounts and providing clear communication to patients that will help them understand their bills. Again, the secret to success is to have a system in place that makes it simple to stay on top of bills and reach the responsible parties. A medical billing company can take care of that for you.

Insurance Verification and Approvals Can Easily Be Outsourced

Seeing a patient without making sure that their insurance covers the visit or any treatments given means you won’t get paid. Checking on each patient, every visit, is time-consuming, but necessary. Let your medical billing company take care of it.
The medical claims process really starts here, with verifying that a claim can legitimately be submitted. Medical billing staff in a company outside your office can focus on just this task, unlike in-house staff who must also take care of patient business.
Likewise, preauthorization, or precertification, is a necessary part of the medical practice management system that can take away from giving attention to patients. A good medical billing company will have trained staff who are familiar with the process of dealing with insurers and obtaining the necessary authorizations.

Get Help with Credentialing for Insurers and Government Payers

You not only have to be confirmed as being qualified to deliver medical services before you can get paid, but in many cases, you also have to be approved to be “in network” with the payer. It is a process that can drag out over a long period of time, but it doesn’t have to.
The credentialing process is just more paperwork, but it can be confusing for someone who isn’t familiar with all the documentation that is required. Failing to submit any of the necessary information or forms will derail the process, and unless someone can stay focused on getting it done, you will continue to lose revenue.
Medical billing companies like Medcare MSO, which provide additional revenue cycle management (RCM) services, can take care of credentialing and ensure the process is completed.

Medcare MSO is a full medical revenue cycle management company with a great track record in increasing revenue for our clients and providing outstanding customer service. In addition to a large team of medical billers, Medcare Force is our specially trained team providing all aspects of both front and back office services. Give us a call today at 863-640-6409 to find out how we can increase your revenue and help you enjoy your medical business more.