A physician’s day is as packed and busy as a highway. You’re busy seeing patients, performing procedures, and studying new treatments. The last thing you want on your plate is to worry about your medical billing execution. But the unavoidable truth is that a healthy practice depends on a healthy revenue cycle. Ignoring the business side of medicine can become a bigger mistake on a practice’s part. Without any hard and fast rules to follow, some simple medical billing tips could help your practice attain streamlined revenue without any hitch.
The Importance of Medical Billing
Your clinical documentation is the foundation of every claim. Even when your staff is handling the billing execution for you, it actually begins with the clinical notes you provide.
If your notes are incomplete, it is impossible for your billing team to do their job well. Incomplete or inaccurate medical documentation leads to claim denials and delays. These errors make the claims incompatible, putting a dent in your cash flow in turn.
We understand that the billing efficiency is foremost the responsibility of your billing staff, but it begins with the documentation you provide. It becomes a partnership between the managerial and the clinical staff. To avoid any wrong moves from the team, we are providing you with some tips that shall help you with the increased reimbursement value.
Medical Billing Tips for Better Claims Processing
Think of your practice’s revenue cycle as a long chain of procedures. It starts with the patient’s first call and ends when you receive payment. Every link in that chain has its own role. A weak link, such as a missing piece of information, can impact the strength of the chain. It not only loosens its links, but can also break. In the same way, establishing a strong procedure value for your billing claims enhances the strength of your claim, resulting in a better reimbursement rate. These physician billing tips are designed to strengthen every part of that chain.
- Nail Your Documentation
The most important tip of all time for your billing processes is the accuracy that you must ensure in the documentation. Your clinical notes must be detailed and accurate, identifying each tiny detail precisely. They should tell the complete story of the patient’s visit. It becomes the basic source of all billing information. A few details that you must see to in the clinical documentation’s accuracy include:
- Justify Medical necessity: The patient notes provided must entail all the details clearly, what services are needed, along with the medical necessity stated. A procedure or test must be medically necessary. Your documentation must support this.
- Be Specific: Vague notes can cause big problems. You can’t just write “patient feels better.” The exact patient condition has to be clarified in the notes. For example, write, “Patient reports a 50% reduction in pain.” Patient’s condition specified accurately helps your coders choose the right codes and modifiers.
- Sign and Date: Always sign and date your notes. This is a basic rule. It proves the note was written at the time of the visit.
The claim discrepancies begin a 90% from the issues with the documentation in the claim. When you give it even a little more time than before, you will see better results in the claim processing.
- Gathering Patient Information at the time of the Check-in
Billing errors often start at the time of patient intake. Make sure your front desk staff verifies all pieces of information collected from the patient.
- Verify Insurance: Check the patient’s insurance card at every visit. Make sure it’s current. A simple call to the payer or an online check can prevent unwanted headaches later.
- Gather Correct Patient Demographics: A simple typo in a name or address can cause a denial. Make sure the patient’s information is entered correctly. A better practice is to verify the patient demographics once more after entering all details.
- Confirm Eligibility: Make sure the service the patient requires is covered by the patient’s plan. This helps in preventing any surprise bills for the patient. It also reduces the erroneous policy details input, reducing the claim denials.
- Adapt the Art of Coding
Coding is the language of medical billing. You might not have to be a certified coder, but you must be privy to all the basics. It is an intricate part of the claim filing, and requires being absolutely accurate to ensure the claims pass the first time. It is a mandatory procedure to help with the denial management in healthcare. To help with the accuracy of your claims for the codes and modifiers, follow the following tips:
- Understand the E/M Codes: Evaluation and Management (E/M) codes are used for office visits. The code you choose depends on the complexity of the visit. This includes the patient history, the examination, and medical decision-making. You must choose the right level of these codes to get paid correctly.
- Know Your Modifiers: Modifiers are two-digit codes that provide all the circumstantial information about a service. These details include the location, number of providers and practitioners involved, procedures applied, and other associated details. Knowing the exact modifiers needed is a key component of the healthcare reimbursement strategies.
- Utilizing latest Codes & Modifiers: The medical billing codes are always changing. It is vital for practices to keep their staff trained for the latest coding updates. This helps avoid any coding issues in the claims and possible denials.
- Drive Better Focus Towards your Accounts Receivable (A/R)
Your A/R is the money owed to your practice. Keeping track of these accounts is vital in ensuring that you receive your rightful payments. Now, how to track these pending payments is the trick. For your ease, we have compiled some tips that shall help you with this tracking:
- Claim Tracking after Submission: Don’t just send claims and hope for the best. Track them regularly. Make sure they are received by the payer.
- Follow Up on Denied Claims: Denials are the greatest issue in a difficult revenue cycle. Don’t let these denials stay in the pile. Your team should have a set process for denial management in healthcare.
- Don’t Wait Too Long: Insurance companies have deadlines for all claim submissions. Make sure you submit the claims and the denial re-submissions as soon as possible. Don’t let them outrun their submission deadline.
- Implement a Strong Denial Management Strategy
Denials are a part of your billing. But when they go pending, it becomes a serious problem for your revenue flow. It disturbs your income flow in a way that affects your practice’s management and the expenditure cycle. Here’s how to handle them.
- Identify the Root Cause: When working on a denial, don’t just fix a single denied claim. Find out the reason behind that denial. Is it a coding error? Or a problem with the documentation? It could also be a patient information issue or a misplaced code. Find the error that has led to the denial of the claim. Fix that particular issue or its leading cause to ensure such errors don’t resurface.
- Categorize Denials: Group your denials by their type. This will help you see patterns in the problems that lead to denials in the first place. This allows you to fix the problem at the very foundation. For example, if you see numerous denials for “Lack of Medical Necessity,” you know you need to improve your clinical documentation.
- Appeal Quickly and Accurately: Have a proper procedure for filing appeals. Make sure the appeal includes all the necessary information required by the payer. A good appeal can turn a denial into a payment.
- Incorporate Advanced Technology
Technology has helped the world advance towards better and faster solutions. A good practice management system can make a big difference as one of your healthcare reimbursement strategies.
- Use a Claim Scrubber: This tool checks claims for errors before you submit them. It catches simple mistakes like typos or missing modifiers. This prevents many denials.
- Automate Reminders: Use your system to set reminders for claim follow-ups. This ensures that no claim falls through the cracks.
- Run Reports: Use your system to run reports on your billing data. You can track your denial rate. You can also see how long it takes to get paid. This data can help you find problems and fix them.
- Work with a Reliable Billing Partner
You don’t have to do it all yourself when there are numerous medical billing companies at your disposal. Many practices work with a third-party billing company to manage their billing execution in a better and professional manner.
- Choose a Specialist: Look for a company that provides billing solutions for your particular specialty. They will have a deeper knowledge of your specific codes and procedures.
- Check Their Performance: Ask about their denial rate and days in A/R. A good company will have low numbers.
- Dedicated Communication Channels: Set up regular meetings to communicate about all your queries. It helps resolve your billing issues while keeping a healthy stream of communication between you and your billing experts.
- The Human Element: Building a Strong Team
A strong billing process is an intelligent combination of human resources and technology. To make the best out of this, stay focused on the following ideas:
- Regular Team Training: Try investing in regular training of your staff. Walk them through the updates that come to ensure they are up-to-date on all regulatory and coding changes.
- Be Open to Communication: Make sure to keep communicating with your team. Talk to them about any issues surfacing in the process, as they see all that goes wrong from the beginning. Keep communicating to make sure you are always privy to the ongoing in your team.
- Developing Accuracy Standards: Set the standards for accuracy at all levels for your team, and appreciate when appropriately achieved. This creates a positive environment among your billers and improves their performance
- Maximizing Your Reimbursements
Putting these medical billing tips into practice will have a big payoff.
- Clean Claim Submissions: When you make sure that your submissions are clean of any errors and discrepancies, your claims are paid faster. This improves your cash flow for a more streamlined revenue generation.
- Prompt Claim Submissions: Timely claim submissions help with faster approvals and reimbursements of the claims. This speeds up your revenue, which directly fastens your cash flow.
Physician Billing Tips for Your Practice
Maximizing your revenue is not a one-time thing. It requires a consistency that delivers results your practice deserves. And these medical billing tips are a good place to start with. Begin with your documentation. Get working with your team. Utilize advanced technical infrastructure and systems. Think about how to strategize your billing execution for a better reimbursement rate. This shall help you have a better revenue cycle management, so that you can deliver your best healthcare services to your patients
