Unless an office or a medical practice is using the services of an experienced billing provider that's been trained to look for holes in paperwork, there's a good chance that their revenue is not as high as it could be. In fact, one statistic estimates that over 20% of a physician's revenue ends up becoming lost due to loopholes and mistakes in the medical billing process. Here are some tips to improve the billing workflow to ensure that physician practices are maximizing their income.
1. Train Billing and Coding Staff
If an office employs an inexperienced coding staff, they might be missing out on valuable income. With the proper knowledge, staff might not choose the correct CPT codes or assign the wrong diagnosis code or the proper modifier, which gives insurance companies the right to deny a claim. To avoid this pitfall, offices should be sure to provide up-to-date training on the most recent Centers for Medicare and Medicaid Services (CMS) guidelines.
2. Identify the Correct Provider
While it might sound simple, choosing the correct provider to bill can often be confusing. This is why it's crucial to get all the relevant identifying information from the patient before a claim is sent. This way, the billing department will be able to bill the correct payer the first time, preventing delays in compensation.
3. Follow-up Quickly and Aggressively
The billing department corresponds with various parties, from patients to payers. They might be sending out bills, faxing letters, or receiving emails daily. While this can be a lot to handle, it's imperative that they follow up with all of these inquiries on a timely basis. If they don't do so, the physician's income will be delayed. In some cases, insurance companies may decide to deny a claim, even if it is valid.
4. Verify Correct Payments
It might sound silly, but sometimes, insurance companies and patients don't always follow through on payments. If an office doesn't double check that each bill is paid in full, these missed payments might fall through a crack. If an office has received an under payment, it's important to challenge the amount with the payer until they get the agreed upon sum.
5. File on Time
Generally, there's a time limit when filing a claim with a payer. If an office is taking their time when submitting claims, they run the risk of having them denied. Even if the billing department submits the claim before the deadline, they have to be cognizant that it might not be accepted right away. In this case, the secondary claim might be submitted past the deadline of the secondary payer - leading to a missed revenue opportunity.
6. Track Implementation
What's the best way to make sure an office is getting paid for all of the services they provide? By creating a report that tracks each and every service provided for a patient. This way, the billing department can make sure that it is billing for every possible procedure performed by the physician. Even if the billing department is running at 100 percent efficiency, this is a key step, as it often picks up missed revenue opportunities.
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7. Challenge Denied Claims
Unfortunately, there's a 3 - 4% chance a claim will be denied even if it's accurately coded. This risk increases when there are problems with the process, rising to 15 to 25%. In order to get paid for these services, a medical billing department needs to follow up on these denials and respond as necessary.
If you'd like more help getting your billing process in order, we can reviewing your internal processes in a quick audit. We've been providing medical claims billing, coding, and auditing services for years. Just call me at 770-666-0470 to get started or email me at firstname.lastname@example.org.