Medical billing and coding require an in-depth understanding of billing terminologies, state-specific billing and coding guidelines, insurance carrier reimbursement policies, medical specialty-wise insurance coverage, and many others. Solo providers or small practice owners try to submit medical claims on their own. This might lead to inaccurate use of codes, more rejected claims, increased accounts receivables (AR), over/under coding, and chances of external payer audit. It is always recommended to manage your revenue cycle operations from billing and coding experts. If you are managing billing operations in-house then the following tips will surely help to improve your practice collections.
Tips to Improve Your Practice Collections
1. Submitting Clean Claims
Healthcare practices mostly focus on submitting insurance claims quickly without focusing on error-free claim submission or clean claim submission. Most of the time claims get rejected due to demographic errors and are stuck in billing software and won’t reach the clearinghouse. A useful RCM tip would be focussing on submitting a clean claim and entering accurate patient demographics. Focus on verifying the patient and guarantor’s name, ID, gender, date of birth, SSN, address, phone number, guarantor details, and insurance details. Always double-check the information at various claim fields like date of service (DOS), place of service (POS), rendering provider details, date of admission (in case of inpatient), prior or pre-authorization reference number, diagnosis and procedure codes, modifiers (if needed), and a number of units provided.
2. Always Verify Patient Benefits
Whether it’s a new patient or an established patient, always verify patient benefits (or insurance coverage) prior to patient visit. With most of the patients recently opting for high deductible plans, there are chances that planned treatment may not be covered by an insurance carrier. You can call the insurance rep and check for the patient’s insurance coverage against planned procedure codes. If the patient’s healthcare plan is not covering the services, you have to communicate with the patient about the cost estimate and the exact amount of patient responsibility. Your front desk team can manage patient eligibility and benefits using a provider portal, clearinghouse services or simply calling an insurance carrier.
3. Take Prior-Authorization
There are certain procedures where you need to inform the insurance carrier and take approval about a planned treatment called pre-authorization or prior authorization. In certain cases, the insurance carrier might suggest an alternate procedure that might be more economical and provides similar outcomes. You must have a list of procedures that requires prior authorization. Every insurance carrier has a unique list of procedures that requires prior authorizations. If you are not sure about which procedures require prior authorization, simply call the insurance carrier for every planned visit and check for prior authorization requirements.
4. Submit Claims Daily
The longer you take to post charges and submit a claim, the longer it will take to receive reimbursement from the insurance carrier. Most major medical payers process claims in just five to seven business days. Most practices have a timeframe to submit a claim, ideally, it should be 24 hours. If you structure your billing activities by collecting patient demographics, and insurance information, verifying insurance coverage and using correct diagnosis and procedure codes then you will be able to submit clean claims on a daily basis. If you file claims only once a week, your accounts receivable (AR) will grow like anything, which means a bigger backlog to work through that often results in more billing errors.
5. Post the Payments
Most practices won’t keep track of payments received. Not posting or delaying payments would keep your AR artificially high and you could be missing denials. Some providers don’t post the payment regularly as they are getting EFT payments. It might affect working on denied and rejected claims as some payers have strict refiling rules, which limit your time to appeal a claim from the date of the remit. By handling remits within one to two days, you can move the balance to the secondary insurance and bill that much quicker. Or, you can transfer the balance that is due from the patient and generate a statement. It becomes increasingly difficult to collect payments the longer it’s been since the patient’s visit.
6. Double Check Used Codes
Double-check your claims for diagnosis codes, procedure codes, and modifiers. Using accurate codes will depend not only on state-specific coding and audit guidelines but also on medical documents and physician notes. Common mistake any provider can make by choosing diagnosis code/s that are non-billable. Double check should be kept to ensure that you are not under- or over-coding services and procedures.
7. Review Explanation of Benefits
An Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA) is a statement the insurance carriers send after processing a claim received from the healthcare provider. The EOB lists the total charges (amount billed), allowed amount, non-covered charges, the amount paid to the provider, and any co-pay, co-insurance, and deductibles the patient pays. By reviewing EOBs, you can determine if you need to perform a more in-depth investigation into a claim or determine what further actions are needed.
The simplest way to improve your practice collections is to outsource your medical billing services to the leading medical billing company Legion Health Care Solutions. We are providing complete medical billing and coding services to healthcare providers of various medical specialties. Please get in touch with us in case of any medical billing assistance on 727-475-1834 or email us at firstname.lastname@example.org