27 Aug Improve your Medical Billing Practices in 9 Steps
Improve your Medical Billing Practices
To safeguard your medical practice’s fiscal health, it is necessary for services and procedures to be billed correctly to maximize collections. Many physicians do not realize just how much revenue they are losing by not evaluating their medical billing practices. There are nine steps of the billing process to be reviewed and considered. As a medical student, you probably did not receive training regarding the administrative aspects of a practice. Because of this, the physician usually ends up learning through a trial-and-error method.
Percentages of the Allowed Amounts for Services
Most physicians will never collect 100 percent of the allowed amounts from the insurance carriers and/or patients. However, there are ways you can come close. Experts suggest that between 90 to 95 percent of the allowed amount should be the minimum acceptable figure for collections. To do this, you must evaluate every step of the medical billing process.
The 9 Steps of the Medical Billing Process
Each step of this process is equally important, and there are many errors within these steps that can lead to lost revenue. Steps 1 through 5 occur before the clinical service is provided, and steps 6 through 9 occur after the patient has been seen.
- Step 1: Credentialing – This involves verification that each insurance carrier has accurate information for every physician he/she will see and for each location of practice.
- Step 2: Patient registration – The front office personnel should obtain accurate demographic and insurance information from each patient so it remains up to date.
- Step 3: Patient scheduling – Medical staff must verify the patient information is correct, whether or not the patient has a deductible, if that deductible has or has not been met, and how much the copay is.
- Step 4: Insurance verification – The front office staff must verify if the insurance information is accurate, up to date, and if the patient has a new policy.
- Step 5: Patient check-in – The medical staff need to collect outstanding balances, copays, deductibles, and/or refraction fees when appropriate.
- Step 6: Charge capture – The billing personnel should confirm that each service marked on the superbill was provided and that charges were identified.
- Step 7: Claims submission – The medical billers are to remit claims to the clearinghouse for approval.
- Step 8: Accounts receivable (AR) management – The medical billing personnel will determine when payment is to be made, based on the insurance carrier. After this, payment is posted as received.
- Step 9: Follow-up – The medical billing manager should review unpaid/underpaid claims at regular intervals, such as every 30, 60, 90, or 120 days. This is done to correct errors and resubmit the claim for processing.
Common Medical Billing Problems
- Missing information – Medical billers who do not fill in areas on the superbill can cause claim denials. These problems should be addressed by the medical billing manager. The front office staff should be trained to obtain current and correct patient information and to enter it into the computer system. The same is true for medical assistants and nurses who enter information when conducting diagnostic testing procedures.
- Failure to capture all charges – Many practice management software systems allow the medical billing manager to create a variety of reports to determine whether or not the patient who was seen has had a charge entered. Most systems will not indicate every service, so it is crucial that the medical staff enter every billable component accurately.
- Not following up on unpaid claims – The practice will lose revenue when claims are denied and the medical billing personnel allows time to elapse before resubmission. The insurance carrier has a deadline regarding processing of denied claims. When the billing department is disorganized, the practice could overlook a billing error, which will result in denial for untimely filing.
- Inadequate number of medical billing personnel – The physician office should have a certain number of medical billers to accommodate the flow of patients and the number of providers. Established benchmarks offer accurate guidelines to follow to decide how many employees are needed to process claims. Experts recommend one staff person per $1 million of collected income.
- Unmotivated staff – To get billing done right, hire self-motivated medical billers who have an eye for detail and are problem solvers. Look for candidates with a background in billing and coding and who have outstanding references. It is worth paying more per hour for a qualified person than taking a risk on someone who has no experience.
- Failure to designate duties – There are many ways to delineate duties among the medical billing personnel. The billing process requires that you front office personnel as well as billing staff. For large practices, the duties can be divided by insurance payer, amount in collection, functional tasks, or by the level of experience of the biller. Decide which system works best for your office and create a list of protocols and guidelines to detail the billing procedures. Along with a list of tasks for each staff member, this will allows the practice to function smoothly.