Best Practices of Medical Billing

Best Practices of Medical Billing

The medical billing process is arguably the most crucial business operation for many hospitals, ambulatory surgery centers, or other healthcare facilities. Inefficient billing practices, billing mistakes and ineffective follow up can add up quickly, costing hospitals and healthcare facilities thousands of dollars in lost revenue.

The good news is that there are steps you can take to improve your billing practices, saving your practice or facility from lost revenue.

What is the role of Medical billers?

Medical billers are the backbone of your health care organization’s revenue cycle. They enter massive amounts of data, keep claims flowing and deal with denials to help accelerate cash flow. You know they’re busy, but are they as productive as they could be?

Review this checklist of practices and see how many are being implemented in your organization.

•    Set productivity benchmarks and monitor performance.

Benchmarking is measuring key performance indicators (KPIs) and comparing them with national averages and better performing peers. Your claims management technology solution should provide detailed reporting on clean claim rates, timely filing denials and other indicators of what billers do every day so you can improve work processes and rectify problems.

•    Take advantage of automation.

If your processes require billers to intervene manually, they’re probably not highly productive. You need to automate menial tasks through custom programming specific to your processes and workflow.

•    Use reporting to identify opportunity improvements.

A good claims management solution can retroactively review and report the changes each biller makes on claims to help improve in the future.

•    Give your billers opportunities to contribute more value

Being able to review and analyze edits, make decisions and suggest workflow improvements adds value and makes their work more rewarding and productive.

•    Specialize billers by payer type.

Every payer has their own claims rules and guidelines. “Structuring” enables billers to develop strong skills and knowledge in certain areas, which makes them more productive and valuable to your organization for higher retention.

Don’t Make Critical Medical Billing Mistakes

•    Your billing procedures can have a significant impact on the financial health of your practice. Here are tips to help you receive payments faster, reduce risk to audits, and keep your billing staff or vendor(s) productive.

•    Know your payer contracts and medical coverage policies. Not only administration but billing staff should have access to payer contracts with advanced knowledge of individual payer medical coverage policies.

•    Dealing with Insurance Companies and Health Plans

Insurance companies find ways to avoid or delay payment for legitimate medical claims. As a result, health care professionals are stuck between choosing to write off the otherwise collectible debt or fight a long and expensive battle to appeal. You need to deal with insurance companies to ensure you receive your rightfully owed reimbursements.

•    Submit clean and completed claims containing proper modifiers and including authorization numbers on claim forms as incomplete claims can waste resources and bog down the claim process

•    Hold insurance companies accountable

When talking to an insurance company, ask for a reference number for the phone call. Ask for a higher-level employee because not everyone at an insurance company has the same abilities to help you

•    When a claim has not been paid or responded to after 30 days, file a first level appeal. If claims are denied, ensure that you exhaust administrative remedies by filing two timely appeals. Failure to do so could preclude you from filing a formal complaint against the health plan.

Billing processes can be a burden on staff, taking up valuable time and resources. You need to provide fast, friendly and affordable billing options while keeping your practice safe and compliant. With highly trained professionals, you can achieve enhanced consistency and higher recovery rates than competing billing providers.

You need a provider that has reporting and analysis capabilities to help you uncover hidden root causes of issues and engage departments all along the revenue cycle for a cleaner, more transparent system.

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