An efficient medical billing process is one of the unsung but important factors that matters the most for a successful healthcare practice. This process plays a vital role in validating that healthcare professionals are paid for the services they render – timely.
However, the process is complex and easily becomes daunting when a small demographic or patient information error occurs, and it begins creating major reimbursement issues. This is the reason why medical billing best practices should be donned to understand common mistakes in medical billing and how to avoid them in an efficient way, so the costly claim resubmissions and claim denial rate can be reduced.
While professionals in a healthcare facility are engaged in a range of healthcare tasks including follow-ups from patients, insurance companies, and third-party paying authorities, tasks associated with billing can easily pile up. To automate the process effectively, practices must have a medical billing system in place. A number of different medical billing software programs are available in the market today that can help streamline healthcare professionals to improve their revenue management.
Indeed, error-free medical billing is critical for the success of any small medical practice. The right medical billing software can save you time and money and improve your overall billing and coding processes. However, with so many options in the market, it can be challenging to know which software is right for your practice.
If you run a small clinic, look for the best medical billing software for small practices in the market that satiate the needs of small businesses.
Nevertheless, whether you get medical billing software or not, knowing medical billing best practices is imperative to run your revenue cycle smoothly. Read on to learn everything that surrounds medical billing.
What is Medical Billing?
Medical billing is the process of following up and submitting medical claims with health insurance companies and third-party payment authorities to get reimbursed for the services rendered by healthcare providers. The process can be completed by a biller working in a doctor’s office, hospital, or another healthcare facility or by an outside billing service.
Medical billing is a critical part of the financial operations of any healthcare practice. It is important to have a clear understanding of the billing process in order to ensure that claims are submitted correctly and in a timely manner. In addition, it is also important to understand the different types of insurance plans and how they work in order to get the most payment for services rendered. You can follow some basic steps to ensure your claims are processed correctly.
How are Medical Billing Claims reimbursed?
As a biller/coder at a facility, first, you will need to gather the necessary documentation and diagnosis information from a healthcare provider(s) and the medical staff associated with the treatment(s). This will include the patient’s medical records, prescriptions, as well as any bills or invoices for services rendered. Next, you will need to submit the claim to the insurance company. This can be done electronically through medical billing software in place or by mail.
Once the claim has been received, the insurance company will process the claim and determine the amount they are obligated to pay. The remaining amount of reimbursement will then be forwarded to a secondary insurance provider (in case a patient has more than one insurance provider). Else, the patient will pay out-of-pocket, which needs constant follow-ups.
You will need to follow up with the insurance company and patients to make sure the claim is paid promptly.
What is Medical Coding?
Medical coding refers to the process of translating medical diagnoses and procedures into alphanumeric codes. These code numbers are then used for billing insurance companies and Medicare for the services rendered by a healthcare provider. In order to ensure accuracy and consistency, medical coding must be done according to specific rules and guidelines.
The most common medical coding system is the International Classification of Diseases (ICD), which is used to code diagnoses. The ICD is updated every year, and healthcare providers must use the most current version in order to be reimbursed by insurance companies. Procedures are coded using the Current Procedural Terminology (CPT) system. Like the ICD, the CPT is updated annually.
In order to code diagnoses and procedures, medical coders must be familiar with both the ICD and CPT coding systems. They must also have a strong understanding of CMS compliance.
Best Medical Billing Practices and Coding Tips
Healthcare professionals need a robust billing process to run their practices’ revenue cycle and maintain a smooth claim acceptance rate. However, the process needs a thorough understanding of rationalizing and making the billing process more efficient. Here are some tips to consider for medical billing best practices that assist in improving the bottom line of medical practices.
1. Prepare Patient-friendly Billing Statements
Medical billing statements are an important part of patient communication in understanding the services that they are charged with. Not only do they provide patients with a summary of their recent medical charges, but they also give you an opportunity to build trust and rapport with patients.
That’s why it’s important to make sure your medical billing statements are patient-friendly. Here are some tips to get started:
- Use easy-to-understand language
- Avoid medical jargons
- Include a summary of the charges
- Break down charges by date and service
- Provide a point of contact for questions
Making a clear service bill will ensure that your medical billing statements are clear, concise, and easy for patients to understand.
2. Stay informed with Annual Coding Changes
One of the challenges of medical billing is staying up-to-date with the ever-changing coding standards. The coding guidelines are constantly being updated, and it can be difficult to keep up with all the changes.
Updates to the ICD-10, CPT, and HCPCS coding systems are released regularly. One way to stay on top of the coding changes is to sign up for a coding newsletter. Coding newsletters typically highlight the most important changes in the coding guidelines and provide helpful tips on how to apply the new codes correctly.
Another way to stay up-to-date with coding changes is to participate in coding forums. These forums are a great place to ask questions and get advice from other medical billing professionals.
In addition, you can also stay up-to-date with coding changes by attending coding seminars. These seminars are typically offered by coding organizations and provide an overview of the most recent coding changes.
3. Automate the Claims Management Process to Increase Accuracy
There is no question that automating the claims management process can help increase medical billing and coding accuracy. By automating repetitive and time-consuming tasks, such as data entry and claims processing, you can free up your staff to focus on more important tasks, such as providing quality patient care.
In addition, automating the claims management process can help reduce errors and increase efficiency; you can reduce operational costs and improve your bottom line eventually.
If you are considering automating your claims management process to improve the accuracy of medical billing, you should keep a few things in mind.
First, you need to choose the right medical billing software. There are many different types of software in the market, so it is important to choose one that is well-suited to your specific needs. Second, you need to train your staff on how to use the software. This is important because even if software helps in expediting tasks, the inaccuracy of handling software may delay the process.
4. Eliminate Workflow Inadequacies & Save Time
Medical practice is a highly complex organization with many moving parts. From patient scheduling and insurance billing to clinical documentation and prescriptions, there are many opportunities for inefficiencies and workflow issues to arise.
By identifying and addressing these inefficiencies, medical practices can save a significant amount of time and improve the quality of care they provide. Some common workflow inefficiencies in medical practices include:
- Inadequately designed patient scheduling systems
- Ineffective clinical documentation processes
- Lack of prescription automation
- Inefficient insurance billing and coding
By addressing these inefficiencies and inaccuracies, medical practices can improve their workflow and save time. This, in turn, will improve the quality of patient care and the practice’s bottom line.
- To avoid some of the common mistakes in medical billing, you can;
- Take a close look at how patient appointments are scheduled.
- Look for bottlenecks that may be causing delays in the process.
- Make sure that all staff members are aware of their roles and responsibilities in the workflow.
- Streamline paperwork and other processes as much as possible.
Create a system for tracking tasks and progress so that everyone is on the same page.
5. Keep Record-keeping Technology Updated
Maintaining accurate medical billing and coding is essential for the smooth operation of any healthcare organization. With the ever-changing landscape of insurance and government regulations, it is more important than ever to have a robust record-keeping system in place.
One of the most important aspects of medical billing and coding accuracy is having updated technology. This is because the system is constantly evolving to keep up with the latest changes in insurance and coding standards. By upgrading your record-keeping technology on a regular basis, you can be sure that your organization is using the most up-to-date and accurate information.
There are a number of different record-keeping systems available in the market, so it is important to do your research to find the one that best suits your needs. Be sure to consider factors such as cost, scalability, and integration.
By investing in a new system, you can be sure that your coding is accurate and compliant with the latest ICD, CPT, and HCPCS standards. In addition, a new system can help you keep track of changes and updates, so you can be sure that your records are always up to date.
Making the switch to a new system can be a big undertaking, but it’s an investment that will pay off in the long run.
6. Double-check Medical Claims before Submitting them to Insurers
When you submit a medical claim, you’re responsible for ensuring that all the information is correct. This includes the patient’s name, date of birth, date of service, diagnosis, and procedure codes. If any of this information is incorrect, the claim may be denied.
To avoid delays or denial of your claim, take a few minutes to double-check all the information before you submit it. This will help reduce the chances of claim rejections and denials and ensure that medical claims are processed quickly.
It is also a good idea to keep a copy of all of the documentation for all the submitted medical claims in case you need to resubmit it or appeal a decision. If you have any questions about the claims process, be sure to ask your provider or call your insurance company.
7. Perform Audits to Spot Medical Coding Inaccuracies
Medical coding is the process of translating medical diagnoses and procedures into code numbers that are used for billing purposes. The accuracy of medical coding is critical, as it can affect the reimbursement level that a provider receives from payers.
One way to ensure accuracy in medical coding is to audit the claims management process. By auditing claims, providers can spot errors in coding and make corrections before claims are submitted. This can help improve the coding accuracy and reduce the risk of underpayment from payers.
If you are a provider who codes inaccuracies regularly, you may want to consider implementing a claims auditing process. This can help to improve the accuracy of your coding and ensure that you are reimbursed fairly by payers.
8. Outsource your Medical Billing Process
Outsourcing can save you money by eliminating the need to hire in-house staff to handle medical billing and coding. It can also help you improve your cash flow by providing you with a team of experts who can handle all aspects of your billing process, from insurance claims to patient billing.
Additionally, outsourcing your medical billing is a smart way to improve your practice’s financial health. You can save your practice time and money when you outsource your medical billing process. By working with a professional medical billing company, you can streamline your billing process as they are equipped with all the state-wise required information and updated coding and billing information provided.
There are many benefits to outsourcing your medical billing. You can get expert help with coding, insurance billing, and collections with the right company. You can also get access to the latest technology, which can make your billing process more efficient.
Once you decide to outsource your medical billing, you should keep a few things in mind. First, you want to make sure you partner with a reputable company that has experience billing for medical practices. You also want to be sure that the company you choose offers transparency and good customer service.
9. Customize Claims according to your Specifications
Many times, when you outsource your medical billing services, they save you time and hassle by automatically submitting your claims to insurers. But what if you need more control over your medical billing? With a little extra effort, you can customize your medical claims to fit your specific needs.
The first step is to understand the different types of medical claims. Each type of claim has its own set of rules and regulations.
Once you understand the different types of claims, you can start to tailor your claims to your specific needs. For example, if you’re a doctor who sees patients in a hospital, you’ll need to submit an institutional claim. But if you’re a solo practitioner, you can choose to submit a professional claim instead.
You can also customize your medical claims by adding extra information using specific codes provided by your insurance provider.
Common Mistakes to avoid in Medical Billing
Until now, as a medical provider, you are already aware of the importance of billing correctly. Not only does proper billing ensure you get paid for your services, but it also helps maintain positive relationships with your patients.
However, billing mistakes are all too common and can often be costly to you and your patients. One of the most common billing mistakes is failing to document patient encounters properly. Be sure to document all aspects of every patient encounter, including the reason for the visit, the diagnosis, and the treatment plan.
Another common mistake is billing for services that were not actually rendered. This can happen if you accidentally double-book a patient or if you forget to cancel an appointment.
Plus, incorrect coding is one of the most common mistakes in medical billing. This can happen when providers use the wrong codes for procedures or when coders make mistakes when entering information. To avoid this, it’s important to have a system in place to check for coding errors.
Steps to Streamlining the Medical Billing Process
Streamlining the medical billing process plays an important role in managing a positive revenue cycle, which can be dramatically disturbed due to error-prone clinical documentation. Plus, getting insurance companies to pay out timely is often difficult. There are ways to streamline your medical billing process and make it more efficient. Here are a few tips:
- Use Technology to your Advantage: Various medical billing software programs can help you automate and keep track of billing processes.
- Keep Accurate and Up-to-date Records: This includes patient information, insurance information, and treatment details.
- Stay Organized: Develop a system for tracking payments, denials, and other important billing information.
- Stay on Top of Coding and Billing Changes: Medicare and other insurance providers frequently change their coding and billing requirements. Keep up with these changes to avoid errors and delays in payments.
- Communicate with Patients: Keep patients informed of their financial responsibility for their treatment.
Other ways include the use of medical billing software. Medical billing software can automate many of the tasks involved in billing, from sending out invoices to tracking payments. This can save a lot of time and effort, and it can help to ensure that bills are paid promptly.
Plus, a medical billing process gets less tricky if it is outsourced to a third-party company. These companies specialize in medical billing and can handle all aspects of the process, from start to finish. This can be a great option for busy medical practices with no professional in-house unit specified for bill processing.
There are many ways to streamline the medical billing process, but the best way depends on the specific needs of your practice. Some common methods include outsourcing, automating processes, and integrating systems. By following these best practices in medical billing, providers can minimize errors and maximize efficiency.