Improving Medical Billing Processes

There’s probably nothing quite as frustrating for your medical practice than dealing with claims denials. Bringing in a good profit is essential if your practice is going to grow and thrive. Continually dealing with denials leaves your staff spending more time dealing with denials, taking their time away from new claim submission, which slows down the revenue cycle. Here’s a closer look at some of the common reasons claims are denied, and how your medical practice can fight back at these denials. 

You are ready to open your own medical practice. Unless you opt to work with an established group practice, there are a number of tasks that you’ll need to complete before you’re ready to open for business, such as developing a viable business plan, choosing a form of ownership, and getting a start-up loan.

Regardless of which form of ownership you ultimately decide upon, there are some things that must be done as soon as possible before you can start a new medical practice in Georgia.  Like any other successful business – and you are a business, as well as a health care provider – you’ll need a plan, as well as the help of an attorney experienced in setting up medical practices. In addition (but not in place of) your legal adviser, if you are building a practice from the ground up rather than choosing an existing turnkey location you may want to consider hiring a certified professional medical practice consultant.

CMS increasing use of RAC (Recovery Audit Contactor) audits catching unprepared providers in their crosshairs, and commercial payers are using sophisticated data analytics to identify coding and billing outliers as targets for audits. It’s critical that providers ensure that all documentation is as complete and accurate as possible. Here are a few tips to reduce the chances of an audit, or to pass one if your practice is targeted.

Provider credentialing an essential part of making sure your practice gets paid. If a doctor in your practice isn’t credentialed by a Medicaid plan, Medicare, or insurance company, you may not get paid unless out-of-network benefits are available to that patient. Unfortunately, sometimes the actual credentialing process can be time-consuming and frustrating for everyone involved. However, there are a few ways that you can simplify the process while avoiding rejections and saving time. 

Since telemedicine is a fairly new care method for most patients, telemedicine billing can be a bit tricky. The guidelines for billing and coding for telemedicine are still being formed and they’re changing, and how you bill can depend on the payer.

In the past, when billing Medicare for telehealth services, the GQ and GT modifiers were essential. However, in 2018, CMS has largely eliminated the need to use the GT modifier on telehealth claims, although there are a couple unique situations when CMS still wants GQ and GT modifiers used. Instead, “Place of Service POS 02” codes must be used on claims for telehealth services.