Updated: Feb 21
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Maximize efficiency and accelerate reimbursement with these medical billing strategies. Streamline your interactions with both insurers and patients to receive payment for your services in a timely manner.
Speeding up the reimbursement process is crucial for any business, but especially for medical practices. The gap between providing services and getting paid can be lengthy. To improve your cash flow, consider these medical billing tips that can help accelerate the process.
Verify your patients’ information.
Having accurate patient information is just as important as documenting the care you provided. Incomplete or incorrect information on forms like HCFA and UB-04 can lead to claim rejection, as much as inaccurate codes. To guarantee clean patient information on all claims, take these steps:
Proactively request patient demographics and contact information. It may seem simple, but explicitly asking for this information can make a significant impact. The way you phrase your question can also play a role. Instead of asking if the information is current or if it has changed, ask specific questions such as "Is your address still X?" to help patients quickly identify errors.
Confirm patient insurance information. Patients may not always be aware that their records contain outdated information. To ensure accurate coverage, ask patients to provide their insurance ID, policy number, and group number if applicable during the intake process. Verify this information with the insurer to confirm coverage and benefits, including copays, and remind patients of these costs.
In summary, it's important to not only request patient information but also to be mindful of how it's asked.
Establish specific payment expectations for patients.
When you are aware that a patient's insurance will cover your services with an $80 copay, it is important to receive that payment as soon as possible. Follow these steps to ensure prompt payment:
Be explicit about the cost and payment expectations for the patient. Do not assume that the patient knows their copay amount at the time of check-in. Clearly inform them of the copay and request payment at that time. While requesting upfront payment is ideal, be willing to work with patients who may not be able to pay right away.
Implement a system for communication with patients regarding payment. If a patient is unable to pay their copay during their appointment, it's important to follow up with them until payment is received. This can be done through payment reminder letters or automated electronic reminders. If utilizing electronic reminders, consider automating the delivery based on the length of time the payment is overdue. Consider offering monthly payment plans as a viable option for patients who are unable to pay immediately.
Issue patient statements as needed. Ideally, a patient's copay would be the only payment required and their insurance would cover the rest. However, this is not always the case. If the insurer denies part or all of the claim, the patient is responsible for the remaining balance. To communicate this, send a statement to the patient outlining the details of the claim and which parts were denied by the insurer. Additionally, include an explanation of benefits (EOB) from the insurer to provide additional information.
Develop a strategy for dealing with non-paying patients. Unfortunately, it's a common occurrence that some patients will not pay their bills. To effectively communicate with these patients and collect payment, establish a systematic approach. Determine the most appropriate and tactful communication channels for reaching the patient. Decide when it is more beneficial to appeal denied claims to the insurer instead of sending the patient to do so. Utilizing collections should always be a last resort option.
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Ensure that your claims include essential information.
Managing medical billing in-house can result in significant delays when claims are rejected, negatively impacting cash flow. To avoid this, ensure the accuracy of patient demographics and insurance information, as well as the correct provider indication, prior to filing claims. This will help prevent rejections caused by simple errors.
Verify all of your coding thoroughly.
Incorrect medical coding is another common cause of claim rejections. With the vast number of codes for medical services, it's easy to make a mistake. To combat this, utilize claim scrubbers, automated programs that match codes on claims to actual services billed. These programs can identify any discrepancies and provide guidance on how to correct them. However, it's important to note that even with these programs, a professional medical coder should review the findings before making any changes. By combining technology and expert coding knowledge, you can significantly improve your medical billing and coding outcomes.
Develop a plan for addressing rejected and denied claims.
Despite best efforts, rejections and denials are an inevitable part of the medical billing process. It's important to have a plan in place for how to handle these situations as it can greatly impact your cash flow and billing expenses. The good news is that addressing rejected claims is generally straightforward. Review the errors noted by the payer, make the necessary corrections, and resubmit the claim. While the time between resubmission and reimbursement may be prolonged, the process of correcting errors is typically quick and manageable.
Did you know? Addressing rejected claims, while initially stressful, is often a simple and efficient process.
Denied claims can be a more complex issue to address. Payers are supposed to provide explanations, known as Explanation of Benefits (EOBs), but they may not always do so. This can leave you unsure of how to proceed. Additionally, deciding whether to appeal a denied claim requires careful consideration of the time and cost involved. You may choose to have patients handle the appeal process themselves, or outsource the task to a third-party medical billing company for added expertise and support.
Use medical software platforms and outsourced billing companies.
Utilize specialized software and external billing services to improve your medical billing process. Implementing a well-regarded medical software platform can simplify the billing tasks of your front office staff. The practice management aspect of these platforms can quickly handle patient intake and payment processes. Additionally, many medical software platforms include an electronic medical records feature that automatically fills in claim details, enhancing the accuracy of your coding.
By outsourcing your medical billing, you allow a dedicated team of experts to handle the entire billing process for you, freeing up your front-office staff's time for other tasks. These experts often have specialized tools and software to improve the accuracy of billing and speed up the process, leading to faster payment and improved cash flow.
By utilizing medical software and outsourcing medical billing, you can improve your cash flow and have more funds readily available by reducing the amount of money tied up in unpaid claims.
Stay current with industry developments and changes.
Stay informed about changes in the medical field, including updates to laws, codes, and standards in your specialty. Keeping an eye out for these changes can prevent issues with medical billing and coding that may lead to denied or rejected claims. By staying informed, you can ensure a smoother billing process for your team and increase revenue for your practice.