Optimize and Improve the Medical Claims Billing Process

The medical billing process’s bureaucracy and behind-the-scenes complexities mean that the revenue cycle is much more complicated than in the days before the industry started introducing software automation tools to the mix.

The medical billing process today is also so complex that it is typical for bills to take not only days, but months to finalize when patients have a complicated case.

The situation needs constant review, even for the most routine of treatments, given the complexities that come from coordinating internal practice workflow with all the criteria imposed by your claims processing vendors and external clearinghouses. There are many solutions available for your company to accelerate the process of coding and billing, leading to quicker submission times and a boost to your first-pass approval statistics.

Here are 8 ways to optimize and improve the medical claims billing process for your organization starting today.

1. Clarify the Collections Process Upfront

Open, transparent communication with patients is necessary for more successful medical claims billing efforts. Ensure that you speak to prospective patients about their duty to pay for the services rendered. Prior to their first appointment, you can include the specifics in the paperwork patients fill out. It would also be beneficial to have a sign placed in the reception area to explain the payment system, so patients cannot say they were unaware of your policy. Obtain patient billing details that day to facilitate prompt collections, including a copy of their insurance card and a photo ID for your files.

Practices with transparent, upfront billing policies see fewer payment delays and higher patient satisfaction, and verifying coverage before every visit helps avoid billing surprises and improves time-of-service collections.

2. Maintain and Update Patient Files

How do you hope to treat claims billing with consistency if you don’t have clear data on any of your patients? You will need to advise workers to check patient demographics and insurance records at each visit. Why is this needed? For one thing, your patient might have changed employment and now have a different insurance carrier. The nature of their insurance could have changed too a patient may have upgraded to a costlier plan with lower deductibles, or downgraded to a less expensive plan that now needs more out-of-pocket costs. Instead of letting your patients be surprised by an unexpectedly higher bill, make a point of explaining the process as you update their information. Make sure that mundane data like the policy number and subscriber information are double-checked (including the billing address for the insurance company). It’s important that these details match the records of third-party payers. Inaccurate patient demographics and outdated insurance information are among the most common causes of claim denials, which is why front-desk staff re-verifying eligibility at every visit is considered a best practice a Tebra survey found 92% of medical billers wished practices did a better job verifying insurance information.

3. Automate Basic Billing Functions

It is a drain on your business to compel staff members to perform activities that are more easily done by automated systems. It drives down morale and frustrates employees who could otherwise be free to focus on more patient-centric, personalized service. Identify billing tasks that are regular and mind-numbingly repetitive. Tasks include filing individual claims, creating payment alerts and then issuing them, and helping to pick the correct medical billing codes.

4. Train for Success

Every insurance company you deal with has its own specific set of rules. One insurer may require chart notes to establish a primary care relationship on claims for new patients, while another may only need chart notes for follow-up care or non-standard treatment protocols. Update and expand training programs for employees to help billing staff easily identify the necessary filing specifications and access the right patient files. This helps ensure each carrier gets the appropriate details, speeding up claims processing as soon as you submit them.

Missing or insufficient prior authorization and unclear payer-specific documentation requirements remain top reasons claims are delayed or denied — see Viaante’s guide on authorization in medical billing for how to build payer-specific requirements into staff training.

5. Tracking Denials

It is clear that having a system of checks and balances in place can boost first-pass rates, whether a practice depends on an external billing and coding provider or opts to manage claims internally. Take the mindset that any rejection is simply a learning opportunity to strengthen the process instead of berating workers for errors.
Common reasons for denials include:

Physicians are not credentialed properly
You lack appropriate support documentation
Your team uses codes for utilities or services not provided by carriers.

You can see simple steps your practice can take to improve productivity when you monitor denial codes. Sending chart notes to the billing department along with regular billing codes, for example, could save considerable time and improve accuracy. Similarly, if you notice claims for services considered to be “non-covered” are regularly returned, it may mean it’s time to check the coverage verification process as well as the coding protocols.

6. Outsource Your Most Problematic Collections

You and your fellow stakeholders may be hesitant to accept outsourcing work. But keeping an open mind is wise, especially when the quality of your revenue cycle is at stake. Working with a third- party revenue cycle management services firm frees up the workers, leaving experts with the more demanding collections.

7. Enhance Quality Control

For the financial state of your practice, eliminating claim errors is critical, to be sure. However, once a claim is approved, the billing and collecting process does not stop. Medical providers are helping to keep a close watch on the cash flow by using generally accepted accounting practices to post and record payments.

By making a deposit log for each receipt, to be submitted to the billing team, you can increase account balance accuracy. All details required to ensure proper posting needs to be included in the log, as well as to make it simple for a reviewer to confirm accurate payment amounts posted to
the correct accounts.

A log should include these basic details:

Patient name
Account number
Check/Cash Receipt number
Amount due
Date of service or referral reference number

8. Follow Up on Delinquent Claims

How much money is waiting to be posted to your practice? Answering
this query will show you the percentage of pending service of overdue claims.
To assess account ageing, at least one dedicated staff member should be
assigned to decide which claims are not being paid in a timely manner.

You may detect communication problems with insurance
carriers or patients after thoroughly reviewing aged accounts receivable. Are
the delinquencies due to irregularities in billing? Are your comments simple to
comprehend for patients? Is the billing and coding vendor working expeditiously
on your claims?

High levels of delinquency are a symptom of a larger issue.
If you regularly review delinquent accounts with an eye to enhancing results,
you can fix these issues early on when they are easier to solve. Its important to
implement and enforce processes and trends that help your team file claims
faster and more effectively for revenue collection. There may be some
communication difficulties between you and other stakeholders, so a conference
on the subject may be in order.

Ultimately, working with a professional service provider like Viaante Business Solutions will help you to enhance the processes and more effectively collect reimbursements, thus enhancing cash flow.

For Free Consultation, Email us at marketing@viaante.com

For more information, visit www.viaante.com