Running a smooth revenue management cycle ensures financial stability for a medical practice that can work proactively for a successful future. However, the medical billing process is prone to errors and providers need to take essential steps to mitigate the chances of risks and errors affecting their practices’ financial health.
Undoubtedly, medical billing is a complex process of submitting and following up on claims with health insurance companies to receive payment for services rendered by a healthcare provider. The process can be daunting and time-consuming, but it is important to ensure that you are paid for the services you provide.
In this article, we will provide an overview of the medical billing process, including what you need to do in order to get started and how to submit claims. We will also offer some tips on how to streamline the process and avoid common mistakes.
10 Tips to Run an Effective Medical Billing Process
If you’re like most medical practices, you probably dread billing season. It can be a time-consuming and complicated process, especially if you’re not using medical billing software. There are a number of things you can do to stay on top of your medical billing and keep your finances in good shape. Here are a few tips to get you started;
1. Establish a Collection Process to Maximize the Practice’s Revenue
One of the most important aspects of running a successful medical practice is establishing a clear and efficient collection process. In order to maximize revenue, it is essential that you have a system in place for collecting payments from patients.
There are a few key steps you can take to ensure that your collections process is effective. First, you should clearly communicate your policy to patients upfront. They should know exactly what is expected of them in terms of payments, and they should understand any late fees or interest charges that may apply. You should also have a process in place for follow-up with patients who have not yet paid their bills. To put it simply;
- Inform patients about their financial obligations
- Gather patient information
- Check and update patient information regularly for changes
- Update patient information
- Remind patients’ portion of the payment (if not paid on time)
- Verify eligibility of insurance plans on every visit
- Upfront payment collection
- Sending letters to patients to remind outstanding balance
2. Improve Appointment Scheduling
Seeing more patients per day can lead to a significant increase in your revenue. In order to do this, you need to be able to schedule appointments efficiently.
There are a few key things you can do to improve your appointment scheduling and maximize your practice’s revenue. First, you should always try to accommodate your patients’ schedules. If a patient is only available on certain days or times, do your best to work them into your schedule. You should also try to schedule appointments back-to-back whenever possible. This will help you see more patients in a day and minimize the lost time between appointments.
In addition, No-shows and cancellations can have a big impact on a practice’s bottom line. In fact, it is estimated that the cost of missed appointments is nearly $150 billion each year in the United States alone. This is why it is so important for practices to have an effective appointment scheduling system in place.
Make sure you are using a scheduling system that allows patients to choose their own appointment times. This will help reduce the number of no-shows and cancellations. Plus, offer a variety of appointment types (e.g. video visits, in-person visits, etc.) to meet the needs of all patients. Lastly, send reminders to patients in advance of their appointments to reduce the likelihood of no-shows.
3. Train Billing and Coding Staff
It’s no secret that billing and coding are crucial to any medical practice’s financial success. Yet, many practices struggle to train their staff in these essential skills. As a result, they miss out on opportunities to maximize their revenue and improve their bottom line.
Billing and coding training can be a complex and daunting task, but it’s well worth the investment. By taking the time to train your staff, you can ensure that your practice is billing correctly and getting paid for the services you provide. In the end, this will lead to a more successful and profitable practice.
Here are a few tips on how to train your billing and coding staff to maximize your practice’s revenue:
- Make sure your Staff is Properly Trained in Coding:
It is important that your staff is properly trained in coding so they can accurately code the services your practice provides. This will ensure that your practice is properly reimbursed by insurance companies and other payers.
- Educate your Staff on Billing and Coding Resources:
Your staff should be aware of all the resources available to them so they can bill and code more effectively. This includes using medical billing software, knowing all the CPT codes used for diagnosis and treatment, etc.
- Make sure your Staff is Trained according to CMS:
Centers for Medicaid and Medicare service provide guidelines for medical staff eligibility. Make sure they are up-to-date about the information required for the practice and are well-trained and eligible for CMS reimbursements.
4. Managing Insurance Claims Properly
It’s no secret that healthcare is a rapidly changing industry. With the ever-evolving landscape, it can be difficult to keep up with the latest trends – let alone manage your practice’s revenue.
One way to stay ahead of the curve and maximize your practice’s revenue is to ensure that your claims are being properly managed. Claims management is a complex and ever-changing process, but there are some basic steps you can take to ensure that your practice is getting the most out of it.
As a medical practice, you likely have a lot of different types of claims that you need to deal with on a regular basis. And while it can be tempting to just file them all away and forget about them, that’s not the best way to maximize your practice’s revenue.
Instead, you need to take a systematic and organized approach to manage your claims. This means setting up a claim management system that will help you keep track of deadlines, follow up on outstanding claims, and appeal denied claims.
However, multiple common errors can easily affect your revenue cycle medical practice that includes;
- Incorrect information about the patients; name, address, DOB, ID number, etc.
- Inaccurate insurance provider information; contact information, name, address, policy ID, etc.
- Duplicate billing information; Reporting the services and treatment that are unrecognizable and unverified.
- Missing EOB on denied claims; often insurance companies still accept physical claims where if an Explanation of Benefits (EOB) document is not found, correcting the errors gets difficult to find.
5. Minimize Coding Errors
As a medical practice, you rely on coding to operationalize care, however, small coding errors can have a big impact on your practice’s revenue. A coding error can cost medical practice hundreds of thousands of dollars in annual revenue.
With such high stakes, it’s important to do everything you can to minimize coding errors. Here are a few guidelines to help you minimize your coding errors practice:
- Stay up to date on coding changes: New codes are released every year, and it’s important to keep up with the changes to ensure you’re using the most accurate codes.
- Double-check your work: Take the time to review your work for accuracy before you submit it.
- Get help from a coding professional: If you’re not confident in your coding skills, consider working with a medical and coding service provider agency that can help you get away with the billing complexities with their expertise.
To minimize coding errors and maximize your practice’s revenue, consider:
- A reputable coding service
- Training your staff on proper coding procedures
- Performing regular audits of your coding &
- Implementing a coding quality assurance program
6. Promptly Handle Rejected Claims
It’s important to promptly handle any rejected claims from your insurance company. If you wait too long, you may miss the deadline to appeal the decision.
First, you’ll need to gather all of the necessary documentation that the insurance company requires. This may include medical records, bills, and proof of payment. Once you have all of the required documentation, you can start the appeals process.
The appeals process can be complicated, so it’s important to follow the instructions from your insurance company carefully. If you still have questions, you can always reach out to a professional for help.
7. Challenge Denied Medical Claims
Unfortunately, there’s always a chance of claims getting denials due to errors in coding and billing documentation. It is always necessary to cross-check the documentation before submitting your claims. But if your claims are denied, this can be a time-consuming process, but it is often worth it in the end. By challenging denials, you can maximize your revenue and keep your practice afloat.
If you are facing a denial, here are some tips on how to challenge it:
- Understand the reason for the denial
- Gather supporting documents
- Resubmit by making the required changes
8. Improve your Practice RCM with KPIs
Revenue cycle management (RCM) is a critical process for any medical practice. It includes all the activities needed to track and collect patient payments. RCM starts with the initial patient contact and appointment scheduling and extends through to billing, collections, and reimbursement.
A well-run RCM process is essential for a medical practice to be successful. It can help improve patient satisfaction, increase efficiency and productivity, and reduce operating costs.
One way to measure and manage the performance of your medical practice’s RCM process is to use key performance indicators (KPIs). KPIs are specific, quantifiable goals that can be used to track progress and identify areas for improvement
There are a number of different KPIs that you can use to measure RCM performance. Some of the primary KPIs to track include:
- Percentage of claims that are rejected
- Percentage of claims that are denied
- Average time to receive payment
- Average time to complete a billing cycle
- Time spent in managing account receivable
By tracking these KPIs, you can identify areas of improvement within your revenue cycle management and make the necessary changes. Doing so will help to improve the overall efficiency of your medical practice.
9. Know when to Outsource your Billing Process
Outsourcing your billing process can be a great way to save time and money. But it’s important to know when to outsource your billing process, as it’s not always the best solution for every business.
There are a few key factors you should consider before outsourcing your billing process. First, you need to consider the size of your business and the volume of invoices you process each month. If you have a small practice with a limited number of invoices, it may not be worth outsourcing your billing process. However, if you have a larger business with a high volume of invoices, outsourcing your billing process can be a great way to save time and money.
Another key factor to consider is your budget. If you have a limited budget, outsourcing your billing process may not be the best option. However, if you’re dealing with any of the following, it’s time to consider outsourcing your billing:
- You’re not collecting payments on time
- You’re not getting paid the full amount that you’re owed
- You’re not sure if your billing process is compliant
If you’re dealing with any of these issues, it’s time to consider outsourcing your billing process.
10. Tools to Help Maximize your Revenue
While a medical practice’s revenue management can be a complex process, there are many tools available to help you maximize revenue. By using technology to automate and streamline your billing and collections processes, you can free up time to focus on patient care while still ensuring that your practice is financially healthy.
Medical billing software can automate many of the tasks involved in the revenue cycle, from claim submission to payment processing. This can help to improve your practice’s cash flow by reducing the time claims are outstanding. In addition, by using data analytics, you can identify areas of opportunity to improve your practice’s billing and collections processes.
Working with a professional medical billing service can also help ensure that your practice is properly reimbursed for the services you provide. A billing service can handle all aspects of the revenue cycle, from filing claims to getting you a reimbursement, managing denied claims, and challenging them.
There are a number of revenue cycle management tools available to help medical practices maximize their revenue. Here are a few of the most popular options:
- Practice management software – This type of software can help streamline all aspects of your medical practice, from patient scheduling and billing to claims management and more.
- Electronic health records (EHR) – EHRs can help you keep track of patient medical records and information, making it easier to manage your practice and submit claims.
- Billing and coding software – This software can help you with the billing and coding process, ensuring that you submit accurate claims and get paid promptly.
Conclusion
Knowing all the essential parameters for a successful medical practice can be complex. For a rewarding medical billing process, it is vital to associate with a medical billing service-providing agency to minimize the errors and workload that healthcare professionals have in their routine life.
Medical billing service-providing companies know the intricacies of medical billing and insurance requirements where every insurance company may have personal coding requirements. They have experts in managing the medical billing process of multiple practices so you can have more time for patient care and well-being.
Expedite your revenue and let your practice position for a successful healthcare provider.
Related Articles: