Do you see revenues or reimbursement of your practice drop? Inaccurate medical billing and coding might be the culprit. Revenue generation and proper financial growth are essential for the smooth functioning of healthcare practice. Medical billing and coding are the backbones of financial and revenue cycle management (RCM). They ensure that the physicians are being reimbursed for the procedures they perform.
However, healthcare practices face several issues when it comes to the medical billing process. Even a minor error or mistake in the billing process results in the claims being denied or rejected by the payer(s). These claim denials and rejections ultimately affect the reimbursements for the services provided by the physician. Opting for advanced medical billing software and processes ensures timely and error-free claim submission and faster payments. Moreover, it also improves the operational and administrative tasks as well as streamlines the workflow & cash flows.
Impact of errors in Medical Billing:
Inaccurate billing solutions for the hospital not only affect the healthcare practice. Patients and insurance payers are also the ones paying the price for mistakes made by the providers in medical billing.
What to do?
Helping people in pain is what brought you to the field of medicine. The primary priority of the healthcare physician is their patient’s health and quality care. And after all the hard work and struggles, physicians deserve to be adequately paid and patients with proper care.
The key to running a smoothly functioning healthcare practice also involves financial stability and a proper revenue cycle. This means that you have to be on point with your medical billing process alongside medical practice. It involves:
- Accurate information and documentation
- Creating insurance claims in time
- Submitting the claims/bills to respective insurance payers, government entities, etc.
- Follow-ups on the claims submitted
But it’s not as simple as it may sound. The medical billing process comprises several steps and errors along the way.
Medical Billing Process:
Accurate billing solutions and coding eventually result in improved Revenue Cycle Management (RCM) and cash flow. The standard medical billing process comprises ten steps:
1. Patient registration:
This is the first medical billing step, which involves gathering the patient’s personal, demographic, and medical information. It also includes getting insurance information as well as their reason for visiting the physician. Using this information, the patient’s file is set up and later referred to the medical billing process.
2. Confirming the financial responsibility:
The second step of the medical billing process involves determining the patient’s financial responsibility based on the visit. In this process, the insurance information provided by the patient is verified & reviewed to find out what services or procedures are covered and the patient’s eligibility.
If the visit isn’t covered under the insurance, the patient will be the one responsible entirely for the payment/cost.
3. Meeting with the physician (a.k.a., the encounter):
This step involves a meeting between the patient and the physician. Here the patient explains their symptoms to the physician, based on which the physician evaluates the information and makes a diagnosis as well as an appropriate treatment plan.
4. Medical transcription:
This step involves an experienced professional preparing a medical script based on the video/audio recordings of the meeting. This medical script contains all the information regarding that meeting. The information is used to develop the patient’s file and is utilized if they visit for the second time.
Now, the emphasis should be on accurately transcribing medical information. There is no scope for error in medical transcription, as the information is later used for treatment plans and insurance claims. Errors can result in incorrect medical decision-making, insurance claims (possible denials), and reimbursements.
5. Medical coding:
This step involves translating the medical information into corresponding codes (CPT, ICD-10, HCPCS Level II). Following is the info translated into codes:
- Reason for the visit
- Diagnosis of the patient
- Procedures or services performed by the physician
- Place of service (where were the services rendered)
The report containing the patient’s information & corresponding procedure and diagnosis codes is called superbill. This superbill is prepared by the medical coder.
6. Preparing the medical claim:
The medical biller gets the superbill (a form containing all the necessary information regarding the visit) and converts it into the medical claim. This is where the preparation of an insurance claim begins. The medical claim should contain accurate and updated information, or the payment can’t be collected. For this reason, the claims are checked and reviewed for the correct information and amount. As incorrect information can lead to the claim being denied or rejected, therefore, no/late payments. The claim form includes:
- Patient’s information and medical history
- Services or procedures performed.
- National Provider Identifier (NPI) number and the insurance provider details
- Place of service code
Moreover, the medical claim must meet standards of HIPAA compliance, medical coding, and insurance payer’s requirements.
7. Claim submission:
Once the medical claim is reviewed and checked for accuracy, submitting this claim to the payers is next. The claims are submitted to the insurance payer, done electronically today. To ensure the proper claim submission:
- EHR – Electronic Health Records checks the claim for complete/incomplete information as well as the respective medical codes.
- A third party like a clearing house checks the claim for any possible errors in coding or information.
- The insurance payer verifies the information in the medical claims and looks for errors (if any). The payer reimburses the physician for the services rendered if the information is valid and accurate. In case of any discrepancies, the payer can deny or reject the claim.
- In case of rejection, the provider must correct the errors and can resubmit the claim. However, in a claim denial, the payer refuses to cover the particular medical claim.
8. Generating patient’s statements:
Once the claim is submitted, it’s time to generate the patient’s statement for their deductibles. It contains the list of services and procedures rendered by the physician, their respective costs, and the amount to be paid by the patient.
9. Denial management:
In case the medical claim is denied/rejected, the provider has the time to review the rejected claim and resubmit. Sometimes, the payer may cover some of the charges and deny the rest.
Follow-ups are also conducted to make sure the medical claims bill has been paid by the patient.
10. Payment collection:
After the verification process is completed, the insurance company pays the healthcare provider for the services rendered.
This information is added to the EHRs by the medical practice.
Tips for Proper Medical Billing Process:
Streamlining your medical billing and revenue cycle management (RCM) is essential for the healthcare practice. Following are some of the tips that can do just that; help you streamline workflow and cashflows and improve dealings with patients and insurers.
i. Verify the patient’s basic information (e.g., demographic, medical, etc.):
Patient basic information like name, date of birth, insurance information, etc., is important for the insurance claim forms. Note here that the information must be correct & updated as incorrect information may lead to a claim being denied or rejected. Following is the list of the kind of information required of the patient:
- Patient’s demographics
- Patient’s contact information
- Insurance information of the patient
- Insurance ID
- Policy number (if applicable)
- Group number
Verify that the information provided by the patient is updated and the patient’s benefits as well as coverage from the insurance payer.
ii. Inform the patient of their co-payments beforehand:
Informing patients of their co-payment beforehand is beneficial for the healthcare practice. One, it promotes trust, and two, it keeps the patient well-informed about everything ahead. So:
- Inform the patient of their deductibles, i.e., how much, when, and payment method.
- Keep in touch with the patient, and make a proper communication flow (follow-ups).
- Share the patient statements.
- Make a plan for how to manage the non-paying patients.
iii. Ensure the medical claims meet the requirements:
Claim rejections and denials directly impact your revenues and reimbursements. This is why make sure that the claims being submitted include all the information required by the insurance carrier. Ensure that the patient’s complete information (demographic, personal, and insurance) is available and correct.
iv. Double-check the medical codes used in the claims:
Incorrect medical codes are one of the major reasons behind claim denials and rejections, leading to late or no payments. Some common examples are human error, confusion between two codes, etc.
This is where medical billing software, claim scrubbers, or clearing houses comes in! They help in automating the entire medical billing and coding process. This kind of software tags any errors found in the insurance claim and provides options to correct them.
v. Manage the claim rejections and denials properly:
Claim denials and rejections are common but can impact the healthcare practice’s revenue cycle management. This is why managing them on time and properly is essential. Claim rejections require to be corrected of the errors highlighted by the insurance carrier and resubmit the claim.
vi. Engage a medical billing software or outsource your billing services:
Several medical billing software(s) are available in the market today. And with the increasing number of software(s), choosing the best option can get very difficult for the providers.
Though medical billing software has several benefits, e.g., streamlining your workflow and cash flow. Outsourced billing services are yet another best option for the healthcare practice. In this scenario, a team of highly professional medical billers is handling the entire billing process. Now, selecting the best medical billing services company is crucial for a smooth and effective billing process.
Get accurate billing solutions with UControl Billing:
Outsourcing medical billing to UControl Billing has several benefits for the healthcare practice’s growth and stability. For instance:
- Affordable and competitive pricing
- Faster turnarounds
- The lesser risk of errors in medical billing
- Higher reimbursements
- A team of highly professional medical billers and coders
Our medical billing services include:
- Fee schedule review and analysis
- Eligibility verification
- Referrals, Authorization alert, Claim tracking, reduced rejections, and denials
- Patient statement processing, Mailing, Customized Monthly financial reports
- Rules-based claim review, scrubbing, Insurance follow-up.
- Helping with a collection agency to recover patient balances
- Always remain HIPAA Compliant
Frequently Asked Questions (FAQs)
1. How do I find a good medical billing company?
U Control Billing is a well-reputed medical billing outsourced services company offering various services for your healthcare practice. With U Control Billing, you get:
- Faster turnaround
- Affordable pricing
- Advanced medical billing solutions
- The highly experienced billing team
2. What are medical billing companies?
Medical billing outsourced services companies handle your billing process so you can focus on your patients. These companies ensure error-free claim submission, the proper medical billing process, timely payments, and revenues.
3. What is the meaning of billing a company?
A billing company is hired by healthcare providers to handle their billing process. Outsourced services companies like U Control Billing handle everything from:
- Claim preparation to claim submission
- Claim denial management, and many more.
4. How do I ensure my billing is accurate?
Some tips for proper medical billing and coding include the following:
- Verify the patient’s information (demographic, medical & contact, etc.)
- Make proper payments plans
- Ensure correct information in the medical claims
- Cross-check the medical codes being used
- Proper denial management
- Adapt medical billing software or outsource your billing services to U Control Billing.
A couple of years ago, I executed the effective plan of creating a Medical billing and Coding company named U Control Billing. The company aims to bring revolutionary advancements to foster medical billing and coding revenues. As an official member of HIA-LI and MGMA, I feel honored in providing networking opportunities, problem-solving, and improving the revenue management cycle.