The dynamic healthcare industry is constantly changing and medical practitioners have to stay on top of the trends to prevent any revenue losses for their business and must keep themselves informed of any alterations in billing regulations.
According to industry sources, independent medical practices are currently missing the opportunity to gain 30% potential revenue because of an inefficient billing and collection procedure. The main reason for this is the high rejection and denial rate. There is a 5-7% loss in revenue because 50% denials are never worked. A large number of denials can lead to the revenue being locked in accounts receivable which can result in an inefficient cash flow.
Medical Billing Strategy
Medical practitioners need to develop a strategic plan to organize their responsibilities. The ideal way to go about this is to form a detailed plan, outlining and providing information for every step of the procedure. The billing method can be thoroughly tracked through this and shortcomings can be identified and improved at every step. The revenue cycle management can be upgraded by increasing authenticity, and patient satisfaction and provider-payer relationship can also be enhanced. This is achieved by making sure that all parties are provided with accurate bills.
According to a survey, there are errors in around 80% of medical bills, which then causes denial or rejection because of insurance payer’s policies. Even though they can be resubmitted, this entire procedure is very time-consuming.
To save time, a proper claims management process should be developed. Billing software can be used to ensure that accurate claims are filed. Equipment and resources can also be used to track paid and unpaid claims. Claims should be verified to monitor any errors before they are submitted. Through this, practices can successfully reimburse their claims.
Correct medical coding is the most important step in Healthcare Revenue Cycle Management. Accurate coding is not only compulsory but also prevents claim denials and rejections.
Cases should be coded by certified medical coders. Non-specific diagnosis codes should not be used. Rejection and denials can take place to employ the classification codes which are less specific instead of the ICD-10 which are more detailed. In the case of incorrect modifiers, claims can end up in rejection. A charge reconciliation process should be employed to prevent charge leakage.
Scrubbing in the claim preparation process is the most important part. The primary aim of the claim scrubbing is to find errors that are left during the clam preparation process and this auditing helps to find those errors. If these errors are detected right before the claim submission of claims it saves lots of time and energies which is required to fix it afterward. Some medical billing services providers use third-party claim scrubbing and also takes help from clearinghouses but if a medical billing service provider does no provide claim scrubbing then there are chances that you would end up putting your energies in claim follow-ups.
It is not like that you prepared a good payment claim and then forget to ask the payer about the status of the payment. The timely follow-ups and inquiring the insurance companies about the status can expedite the process. In this way, you can easily find if a claim is denied due to some errors in it, and through timely correspondence the claim acceptance rate increases. This is the reason most medical billing companies have a well-planned follow-up process that helps to close the billing loop well in time.
An effective denial management system is essential in establishing a healthy cash flow. Industry sources indicate that 50% of the denials fail to be reworked which means 5-7% of potential revenue is lost.
Denials should be worked within 2 days of being received and during insurance follow-up, they should be the priority. A detailed list of claim adjustment reason codes (CARC) should be developed, and similar follow-up actions should categorize them. To decrease the denial rate in the future, preventative denial analysis should be conducted to identify the root cause.
Revenue Cycle Management
RCM services should be used to adapt to the dynamic healthcare field. To identify errors and introduce strategies to manage the problems, performance can be monitored and the latest rules and regulations should be followed.
To determine the outstanding bills, aging accounts receivables should be monitored. Stay up to date with billing rules and modify your procedures accordingly. A billing solution should be employed to manage accounts and to track potential problems and errors. Key identifiers can be utilized to counter issues such as late payments, changing contact information, or declined payments, etc.
Managing to bill in-house makes it difficult to stay up to date with the recent coding and medical billing rules, federal regulations, and insurance companies. This can increase rejections, leading to profit losses for the business.
Expert medical billing service providers can be contacted for consultation if the business is facing problems with collection management. Not only do they have the experience, but they also have the resources to manage the accounts receivables for the business and improve its financial health.
Only a well-planned billing process helps to increase the collections of medical practices. The practices which neglect to bill and only keep their focus on the care delivery process can lose a significant part of their revenues. The billing process starts from the front office where the accuracy of the information is a must to start the woe process. The billing team moves on to check the eligibility of the patients from insurance companies and which ensures that the care providers have secured themselves from initial denials. Only then it is followed by coding, billing, and collections.