If you’ve read any of our previous blogs on revenue cycle management, (here and here) then you know that medical billing is one piece of the larger RCM process. While RCM encompasses the entire journey to reimbursement, the medical billing process is the backbone that supports all the other processes. In other words, if the billing process is not well defined and effective, the other steps will not be either.
The end result of a malfunctioning RCM? Lost revenue, which no one can afford.
What can you do to ensure your medical billing process is effective and fully functioning? We have decades of experience helping medical practices like yours assess and improve their medical billing process. The result? Timely payment and increased revenue.
Step 1 – Improve the Patient Registration Process
At arrival, ask the patient to provide their pertinent contact, insurance, financial, and demographic information. It seems easy enough. However, if this step is riddled with mistakes or missing information, it holds up the rest of the medical billing process.
To improve the patient registration process, invest in front-end staff training and create a fixed and repeatable process.
According to a survey by ClaimRemedi, 80% of rejected claims have issues with insurance eligibility. By thoroughly training staff on what information is needed to verify insurance eligibility, you will instantly improve your claims processing.
Further, ongoing training should be a primary function of practice management. It should not only occur at employee onboarding but should also be updated as health insurance requirements evolve. This will ensure your staff is properly educated on information needed for insurance eligibility verification.
Step 2 – Reduce Medical Coding Errors
If medical billing is the backbone of the RCM process, coding is the heartbeat. When procedure codes are not reported correctly, the whole system goes into shock until mistakes are remedied. A few of the most frequent but easily fixed coding mistakes are:
- Not coding at the highest level of specificity
This is job number one for a medical coder. If a coder is not educated in medical terminology or doesn’t receive detailed and accurate notes from the provider, you risk coding to a general level which can lead to a claim denial or reduced payment.
- Missing or sloppy documentation
As a provider, if you are not presenting a coder with detailed procedure information, or the information is sloppy, then a coding error may be your problem to solve. By taking detailed and organized notes and offering as much information as possible to the coder, you decrease the risk of claim denial because of non-specific coding.
- Improperly or under trained coding staff
Your coders are only as good as the training they receive and their knowledge of the medical billing and coding process. By investing either in a skilled outsourced or in-house coding staff, you can drastically reduce claim denials and due to medical coding errors.
By diligently monitoring your medical coding process you not only grease the wheels for the claims submission process to come, but also avoid costly claims denials.
Step 3 – Increase Accepted Claims
This is the process where you can evaluate the accuracy and effectiveness of the patient registration and medical billing processes. The average claims denial rate is between 6%–13%. In 2021, the research firm Harmony Healthcare found more than 30% of all hospitals were in the “denial rates danger zone” meaning they were experiencing a more than 20% increase in denial rates.
- Insurance companies are guaranteed to deny your claim if patient information is missing or incorrect. Even the simple transposition of numbers on a member ID will result in claim denial. Accurate and complete patient and billing information is imperative.
- Claims are not submitted in a timely manner. An efficient billing department should meet or beat payors’ filing deadlines. To that point, billing departments must also track these deadlines since they often differ by payor.
- Discrepancies between procedure and diagnosis codes. For instance, if a pregnancy related code is mistakenly entered on a male patient’s claim, the claim will be denied. This goes back to coder training and detailed and accurate provider documentation.
A denied claim puts you back at square one and means your office must correct the error and then re-submit the claim. This results in lost revenue in terms of additional man hours and delayed revenue in terms of timely payment.
Step 4 – Customer Service is #1
Undoubtedly, you will have to chase down payments for balances owed while also being on hand to answer incoming patient questions about bills. In addition to outstanding organizational skills, your billing department must be customer service savvy — friendly but knowledgeable.
Patients may experience stress during medical treatment and medical debt only adds to the strain. This stress may be transferred to whomever answers the phone. Empathy and helpfulness go a long way when dealing with patients whether you’re following up on an overdue payment or discussing payment concerns. The more trained and informed your billing services and accounts receivable department is, the more likely your cash flow will increase.
Step 5 – Outsourcing Could be the Solution
If after evaluating and improving steps 1–4 of your medical billing process your number of accepted claims has not increased and your revenue isn’t increasing, an outsourced medical billing team could be the answer.
Often, because an outsourced medical billing services team is solely focused on billing, they are more capable of staying up to date with health insurers’ claim submission and eligibility requirements, as well as changing industry and government medical billing regulations. By ensuring you start the RCM process with the correct information, you can significantly improve your claim acceptance rate.
Another benefit of an outsourced medical billing team is its ability to follow up with payers continually until claims are accepted and then paid. Medical coding errors are often reduced because, like the payer eligibility requirements, an outsourced team is constantly trained on the latest medical coding protocols.
In the end, the effectiveness of your overall medical billing process hinges on hiring and training the right people. The team must be equipped with the training, tools, and information needed to complete the billing process and ultimately receive timely and accurate payment.
Gryphon Healthcare has been helping healthcare organizations like yours increase their profits for years. We’re healthcare professionals like you and we understand the way medical practices operate. We are passionate about improving your medical billing process.
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