Business

Medical Billing Tips to Maximize Revenue

Complex processes for claims and billing can often make it difficult to collect the money your practice has earned. Frequent changes to the U.S. healthcare system often leave care providers and patients both playing catch-up as they adjust to new processes.

As a result, a practice may notice that they are not bringing in the revenue that they should, even though their practice is receiving enough patients. Billing errors, rejected claims, and delays in compensation all put an unnecessary financial stress on the office. So, how can you ensure that your practice is maximizing revenue through the billing department? Here are 5 basic tips:

  1. Stay Up-to-Date on Changes in Paperwork Requirements

One of the biggest things you can do to help your practice is to stay up-to-date on the latest changes in requirements. After all, how can you prepare your practice, your team, and your patients if you don’t even know what changes are being made?

There’s so much red tape and specific process requirements when it comes to getting your practice paid. Everything needs to be filed just so. In order to get the payments your office needs more quickly, you need to start with a thorough understanding of these requirements and any changes that may happen. 

This also means spending time and money on education, software, and staff training. Just as much as you need to understand changes in requirements, the billing department and others involved in collecting patient information need to be updated too. Though it may seem like another expense you can’t afford, it can save you a lot of time and money in other ways.

2. Create and Communicate a Clear Process

Once you have a full understanding of the requirements and rules related to your billing department, you have to establish a clear process and then communicate it to your team. It’s not enough to make sure that everyone is educated on the requirements. Instead, there must be a system and a routine in place with checks along the way to ensure that these requirements are being met, eliminate errors, and prevent wasted time on rejected claims.

This process should include every step of a billing cycle. It starts when the patient enters the office: informing the patient about their responsibility to pay for services, collecting and verifying patient and insurance information, gaining proper permissions, etc. This process should then extend to collecting. Try to collect payments up-front. If that’s not possible, discuss payment options with the patient as soon as possible. Also, establish a protocol for how the patient will be contacted about payments and how often to contact.

These seem like basic, obvious things that everyone should be doing. Many in your office may be doing it correctly. But, without an established and clearly communicated process, it’s all too easy to skip steps or accidentally brush over something important. Creating a routine with regular checks will help decrease any accidental oversights.

3. Decrease Coding Errors

When filing a claim, medical coders use a standardized set of codes to describe what kind of care the patient received and what the claim includes. While these codes make it easy for everyone to get on the same page, there are some common coding errors that result in rejected claims and require revision.

Two of the most common errors are non-specific diagnosis codes and incorrect modifiers. Non-specific diagnosis codes refer to an issue with collecting patient data. Current requirements need more detail on the patient situation than before, and often all of this detail is not collected initially. Incorrect modifiers are pretty self-explanatory. Either the modifier describing the patient/treatment is missing or it is not accurate. When these errors occur, insurance companies may deny or reject the claim, resulting in an even longer wait for reimbursement.

Decreasing these errors means increasing employee training and the frequency of refresher courses.

4. Follow-Up Quickly

Everything moves rather slowly through the billing cycle, so, when it’s in your control, it’s best to move things along as quickly as possible. From collecting patient data to collecting copays to filing claims to handling denials and rejections, minimize the follow-up time as much as you can.

Make sure that your billing department understands that handling paperwork promptly is a priority. Clearly establish which tasks take precedence over others so that everyone is on the same page about what needs to be moved quickly and what can wait.

This is also essential because there is a time limit for filing a claim. A slow process increases the possibility that the insurer will deny the claim, even if it is otherwise valid.

5. Work with a Consultant

Getting your medical billing department into shape can be a lot of work. Sometimes, it’s hard to tell where to start. Once you know what the problem is, solving it can be easy. However, finding what exactly is the foundation of your revenue issues can be a lot more difficult.

If you’re trying to solve a revenue issue in your own practice but are struggling to balance the demands of your current position with this undertaking, consider looking into medical practice management consulting firms. The consultants at these firms are trained to help you identify and correct problems within your practice. They have years of experience working specifically in the medical field, and they have seen it all.

Where you may struggle to identify what is causing your revenue to come in so slowly, these consultants will be able to recognize patterns and offer you their expert advice for the best ways to solve the problems in your practice.
Medical billing is a lengthy, sometimes confusing process. It’s estimated that about $125 billion is lost to medical billing errors every year. If you’re struggling to maximize revenue, you’re certainly not the only one. Go back to the basics and create structure and accountability within your department. And if you need help, don’t be afraid to ask for it! Soon, you’ll see things start to run more smoothly and have a thriving practice.

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