Crucial Steps To Devise The Perfect Plan For Effective Medical Billing

Just like other businesses, the healthcare industry is also rethinking the way revenue cycle management happens. Because the ongoing circumstances have entirely changed the ways, one can deal with the financial uncertainties, caused by the pandemic. Physicians, particularly in the United States, are still struggling to get out of the financial crisis. Such as; frequent claim denials and unpredicted revenue leakage. For this purpose, they must have strategic plans in place. That enables physicians to successfully deal with both medical and non-medical obligations. As everyone knows the healthcare payment process or “revenue cycle,” always remains a hot topic in the medical industry. This is quite complicated and revolves around the main three stakeholders including; patients, physicians and insurance companies.

Moreover, the transition from fee-for-service models to value-based care (VBC) models have drastically impacted healthcare reimbursements. Healthcare experts have predicted that in upcoming years more reimbursements will be tied to VBC than traditional reimbursement models. However, it all depends on the ways healthcare providers manage their medical coding and billing tasks. With every passing day, the healthcare industry is witnessing constant evolutions that require immediate action plans to deal with. For example, strict policies established by the insurance companies (both government and private entities), federal/state laws, billing guidelines, and constantly updating medical codes require attention to detail.

It also demands unique expertise and skills to keep the physician billing services free from all the possible inefficiencies. That eventually results in delayed, partial, or denied reimbursements for the medical care services provided to the patients. The golden rule of thumb to keep a healthcare revenue collection management optimized is to embrace the innovations. Because in this challenging era, only those healthcare providers stay in the competition, who change the strategies to manage their billing and coding services according to their needs. Before further discussion, let’s shed light on some statistics regarding revenue loss.

According to a recent report compiled by the American Hospital Association and Kaufman Hall: Healthcare practices are likely to face a loss of above USD 120 Billion in 2021. Unfortunately, the statistics are worsening day by day. Therefore, medical practitioners are eagerly looking for innovative physician medical billing solutions. Are you lagging behind your revenue goals and aren’t collecting what you actually owed? If so, then it simply indicates that there are inefficiencies present in the medical billing systems. So, in order to save your healthcare practice from further financial loss as well as critical crises. It’s important to devise the perfect strategies to make sure that your RCM system becomes capable of generating more revenue.

This article will take you through the top know-hows. That can help physicians in unlocking maximum revenue by increasing the efficiency of the medical billing services.

1. Breaking Down Steps of Physician Billing

Breaking down the steps involved in the medical billing services can help you to better understand the areas. Which need particular attention and improvement as well. It might seem very basic and may all of you know about these steps.
But discussing such steps again is just a wake-up call for the medical care providers to pay keen attention to every step to get maximum payments.

Patient scheduling/ Registration: It is the first and foremost step in medical billing. During this step, all the required data i.e. patients’ demographic information such as name, date of birth, age, gender, phone number, address, social security number, and basic insurance information is being collected. This information paves the way to further processing of medical coding and billing.

Pre-Authorization: It is the next crucial step in medical billing. In which administrative staff of the healthcare practices gets in touch with the insurance companies. To verify the coverage of the healthcare services before performing certain procedures. In this way, practitioners will get an idea of whether or not they will get reimbursed for some particular procedures.

Coding the Procedures: Medical coding is considered the lifeblood of healthcare revenue collection management. It is the process of assigning procedural or diagnostic codes to the particular injury, illness, treatments, diagnosis, and healthcare services rendered.

Preparing & Filing Claims: Medical billers work diligently to prepare &submit the medical claims in a given time frame of the insurance companies.

Follow up: The role of billing teams doesn’t end with the submission of claims. They regularly follow up with the payers to stay informed about the current status of the submitted claims, either paid or unpaid.

Patient collections: It’s a fact that patients’ copays and deductibles play a significant role in maximum revenue collections. The best way to deal with such payments is upfront collections from the patients.

Here’s some more insights into why having strong net collection ratio is a KPI to track for your practice.

2. Identify the Areas of Improvements

If your billing system isn’t efficient enough to generate revenue. Then you should revisit the entire revenue cycle management from patient scheduling to payment posting and all in between. In this way, you will become able to identify the loopholes that are causing claim denials. The best thing you can do is a deep analysis of the claims backlog, that is being denied or rejected due to certain reasons. Then prepare a list of the most common reasons that lead to the frequent claim denials. Once you uncover the areas of improvement, you should take preventive measures. That eliminates all the inefficiencies in the RCM process and takes your profitability to the highest level.

But, do you have the time & resources for this heavy task?

A wise practice growth strategy is to outsource denial management services to an expert company. Here are some advantages your practice may get.

3. Implement Smart Billing Solutions

After identifying the causes of revenue leakage the next step is the implementation of cutting-edge RCM solutions. That effectively addresses all your financial challenges. Furthermore, here are the following tips that can help you to keep your denial rate minimal as much as possible.

Switch to Automation
Despite the availability of advanced technology. There are many healthcare practitioners that are still using manual methods for data collection, processing & submission of paper medical claims. All these outdated techniques can increase the risk of errors and ultimately delay the process of reimbursements. However, healthcare providers can utilize their time and resources for a better cause by eliminating the excessive burden with the help of automated systems.

For example, the use of practice management systems to automate the entire administrative workflow from patients’ scheduling to payment collections, etc, will not only save time. But it also increases the level of accuracy in the physician billing process. Furthermore, according to a recent study: rates of automated claim submission, and eligibility verification procedures result in better productivity as compared to the outdated methods.

Elevate Patient-Provider Transparency
Do you know 35% of physicians aren’t transparent in their financial policies and don’t discuss finances with the patients at all? Unfortunately, only about one-fifth of healthcare providers discuss the healthcare costs with the patients. That not only negatively impacts the patient-provider relationship. But also results in significant delays in patient collections. Therefore, healthcare providers should be more transparent when it comes to dealing with patients for their financial responsibilities. It will help them in collecting the revenue from the patients without delay and automatically improve the cash flow.

4. Outsource RCM Services

Due to its immense benefits, physicians are rapidly stepping towards outsourcing medical billing and coding services. In this way, they get the maximum return on investment without excessive financial and administrative burdens. Outsourced billing and coding experts are legally responsible to make sure that medical claims are being handled efficiently. However, dealing with outsourcing partners will not be easy if you are not aware of what KPIs to measure when outsourcing.

Also, you need to know key terms & components of a healthcare contract, to better understand what you are getting. They work hard to submit the claims according to the following standards:

  • Accurate patients’ information.
  • Valid insurance information.
  • Precise medical codes.
  • Error-free charge entry.
  • Claims scrubbing: that set claims free from potential errors.
  • No duplicate billing.
  • Timely submission of clean medical claims.

Related Article: What Are The Fundamental RCM Metrics Your Practice Should Know?

When medical claims are submitted according to the above-mentioned parameters. Physicians enjoy the maximum reimbursements and streamlined cash flow. Choosing the best partner for your billing needs is undoubtedly a hectic task. But don’t worry, you don’t need to look further. Physician Billing Company is a one-stop solution for all your healthcare revenue cycle management goals & financial challenges. It helps healthcare providers across the United States in achieving their economic goals with a custom Revenue Cycle Management System that combines advanced technology. Contact us today to acquire the much-needed assistance.


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