As if the medical billing codes weren’t challenging enough, insurers are making it harder for medical providers to get paid—but that doesn’t mean your practice has to suffer. It just means that it is more important than ever to have effective medical billing services in place.
Access to software that is constantly updated to keep up with code changes is critical, but it isn’t enough. You have to also have people who are experienced in dealing with the less common codes and complexities, such as when there are medically necessary exceptions to what is included in bundled codes.
The best medical billing services also have a system of claims tracking to ensure that all services are billed and old accounts receivable (AR) is managed so denials and rejections are not abandoned. The following are six key aspects of efficient medical billing services that should be part of your revenue cycle management (RCM).
- Make sure to have current codes and payer information—Codes change annually, and payers modify their rules and requirements even more often. Use of an obsolete code will result in an immediate denial when the claim is reviewed, and payers do not make any effort to help sort out the error. If there are errors in the information required for submitting the claim, it will be denied without even being entered into the payer’s system, even if it is because they just changed their rules.
- Collect any known patient payment at the time of service—Prior to the patient arriving for their appointment, you should verify insurance eligibility and get any necessary preauthorizations. During this process, you can also find out what part of the bill the patient will be responsible for. At the time of the appointment, any coinsurance, copay, etc. should be collected so it does not have to be billed to the patient in the future.
- Scrub claims prior to submission—After each claim is prepared, the best medical billing services take the step of “scrubbing” the claim, or having an experienced biller review it with an eye to each of the potential errors that would trigger rejection or denial.
- Track and manage denials and rejections—Having claims scrubbed by an experienced medical biller will greatly reduce the number of issues with them, but some denials and rejections will still occur. Failure to rework these claims has proven to be a huge source of lost revenue for all kinds of medical offices. The best medical billing services will track each claim until it is paid, which can be labor-intensive and is one of the foremost reasons for outsourcing medical billing services.
- Send out statements to patients regularly—Not all patient charges are known in advance, and when patients owe money after their appointment, it is important to send a statement explaining how much they owe, what it is for and how to make a payment. It can be difficult to collect from patients, but if you don’t at least inform them that they owe you, there will certainly not be any payment made.
- Review billing statistics—It is important to understand how your medical billing is affecting your revenue stream. Reports should be generated and reviewed regularly that at least show your income, total amount in AR, and time in AR (the average amount of time it takes to get claims paid). It isn’t the numbers that are important to see, but the trends, so the reports should show present and past values for comparison. It is also a good idea to have a report showing income and deposits to ensure that all receipts are making it into your bank account.