The recent modifications that have been made to the healthcare system in the United States have brought forth a range of new issues for both patients and professionals. Many components of healthcare reform, such as the adoption of other time-consuming, value-based pay schemes and the regular adjustments in invoicing rules and regulations, can potentially result in lost revenue for providers across the United States.
It is estimated that around $125 billion in unrecovered income is lost annually by medical providers in the United States due to billing mistakes and a failure to remain current on the laws and regulations governing medical billing. Specialists, like radiologists, have even more significant difficulties owing to the intricacy of their operations and the necessary billing requirements that accompany such treatments.
In medical billing, many things may go wrong, but if you are thorough in creating standards for your employees to adhere to, you can minimize the likelihood that errors will occur. Suppose you communicate clearly to patients exactly what you anticipate from them in terms of reimbursement for the services you provide. In that case, you will have a greater chance of reducing the number of mistakes and payments that are not made.
When it comes to invoicing patients for medical services, you have the option of either handling this laborious task in-house yourself or contracting it out to a reliable outside party. Suppose you are determined to handle patient billing on your own. In that case, the following information will give you some medical billing ideas that will assist you in optimizing patient collection and obtaining every dollar that is entitled to you for each treatment rendered.
Learn how bills are prepared
The billing and collections process may have left you feeling overwhelmed and a bit afraid. However, the first step is to get a good grasp of the process, even if someone else will eventually be responsible for the day-to-day operations.
Even though someone else will eventually be in charge of the day-to-day operations, you should still prioritize knowing the process in its entirety. Taking responsibility for this aspect of your company may prevent fraudulent activity and guarantee that claims are filed promptly.
Set up a straightforward way to collect money
To guarantee the continued financial well-being of their practice, every provider has to have a collection strategy in place. Establishing a step-by-step strategy not only simplifies the processes for all parties involved. But it also can significantly enhance revenue flows by ensuring that patients are aware of their duties appropriately and exhaustively.
Spend money on staff training
After developing a standardized and quantifiable billing method, you will need staff members who have received adequate and in-depth training to put it into practice. Never cut corners on this phase or presume that the only employee who requires training is the one who files the claims.
A healthy revenue cycle starts with front desk personnel that is well-trained and equipped with the tools necessary to verify patient eligibility and coverage, as well as the capacity to collect payer balances at the time of treatment. This is the foundation of a successful revenue cycle. Creating a flowchart detailing the specific stages of billing and collection is another excellent strategy.
Obtain Payments in Advance If Possible
When the patients are still present in your office, it is the ideal moment to collect payment. If you ask patients to pay when they come in for their appointment, you won’t have to spend the time and energy of your staff trying to track them down later.
You are going to want to mention to the patients about the copay that is expected of them. Choosing one’s words and phrases cannot be overstated. Patients shouldn’t need to request that you send their bills to their insurance companies for processing rather than asking them to pay you immediately.
Ensure the Proper Management of Claims
It is estimated that over 80 percent of all medical bills include some mistake. However, these invoices will probably be denied because insurance companies are pretty stringent about accurate medical billing and coding processes.
Submitting an item, having it rejected, editing, and then resubmitting it may take several weeks. Consequently, service providers sometimes have to wait many months before getting paid for their work.
The amount of time and effort lost when claims need to be edited and resubmitted, and claims must be correct and complete the first time they are submitted. This entails entering the information in the appropriate format and thoroughly reviewing the claims to ensure they are free of any mistakes before sending them in.
Quickly Deal with Rejected or Denied Claims
Processing a claim is impossible unless one or more mistakes are found. As a result, the insurance company cannot pay the debt on its whole. Claims for payment that have been processed and declared unpayable are known as denied claims, whereas claims for compensation that have been refused are known as rejected claims.
As in all of these scenarios, the payer will explain what went wrong when they return the claim to your billing department. In contrast, a denied claim must be appealed before it can be resubmitted, which is more expensive and time-consuming than correcting a rejected claim.
Rejections and denials may be minimized by checking for problems in a claim, but if they arise, be sure to deal with them as soon as feasible. If you have questions about your initial or continuing claims, contact a representative from the payer. Many of these things may assist in speeding up the claims editing process and reduce the time required for appeals and resubmissions.
Carriers and contracts should be familiar to you
Patients’ insurance companies will be able to resolve issues more quickly and easily if you continually keep open lines of contact with them. To resolve practice concerns, having a health plan contact in charge of this task is beneficial. In addition, building a compassionate and cooperative relationship with this person is well worth the effort. Practice management teams should regularly monitor the charges, payments, and collections of the practice’s most frequently used insurance carriers.
Any difficulties with these contracts have a higher impact on the company’s total revenue. Your clinic and your patients will be better able to fight back against rejections if you are up to date on the newest healthcare legislation, federal and state rules, and insurance contracts. Whenever you speak with an insurance company, always have a phone number to go back to. The hierarchy of command doesn’t have to be intimidating.
Make use of the most recent advancements in technology
To optimize patient collections, the more you depend on technology, the better. Ensure your team has all they need to handle the billing process by first analyzing the most recent versions of medical billing software. Your patients will enjoy the ease of being able to contact you through an employee portal. It significantly impacts your bottom line if you have better access to invoices and a rapid, digital way to reimburse your practice.
Another aspect of technology that can help your employees work more efficiently is the software’s ability to track who still owes money, for how long, and whose claims have been denied due to staff coding mistakes. In addition, patient reimbursement is more likely to be expedited when a late payment reminder is sent by secure email instead of snail mail which is prone to get lost in the shuffle.
Take Home Message
- In the United States, recent developments due to Covid in healthcare delivery have resulted in difficulties in collecting fees.
- The pros and cons of in-house and outsourcing medical billing.
- Patients pay more time if they know exactly how their money is collected.
- Attempt to collect money at the time of service wherever possible. You may educate your team to use the ideal language to get a good response from your patients.
- The more information you collect from patients when they initially join your clinic, the more prepared you will be to send them invoices or notices.
- Your patients will appreciate it if you use the right software and technological tools.
- Consider using training materials and rewarding your employees for improved payment management.