Healthcare practices have a much bigger responsibility to provide quality and safe care to patients. This is the primary goal for any medical practice, provider, and physician. Along with managing patients, the providers and the administrative staff look after other responsibilities as well. For instance, billing, collections, revenues, facility standards, following the guidelines, as well as managing several insurance payers. Creating a balance between both; patient care and administrative tasks is essential for the functioning of the practice and its growth.
To keep the door to the facility open for patients, proper revenue generation and RCM is necessary. And medical billing has a huge role in getting reimbursements and generating revenues for the providers. The healthcare facility staff, along with dealing with the patients, also have to manage tasks like:
- Medical billing
- Eligibility insurance
- Handling audits
- Documenting medical records
- Reviewing the fee schedules
- Charge entry
- Medical coding, etc.
There is so much on their plate, and doing all of that can be pretty time-consuming and can lead to errors or delays. However, when it comes to medical billing, errors or delays can result in claim denials or rejections from insurance payers. Medical billing is a critical task that requires expertise, skills, and the total focus of the biller. These professional billers are the middle-man, navigating between the patient(s), provider(s), and insurance payer(s). The purpose of medical billers is to generate reimbursements for the medical services provided by the physician.
What do medical billers do?
Everything begins with gathering the necessary information about the patients. It includes personal information, demographics, medical history, insurance information, coverage, eligibility criteria, the services received by the patient, etc. Medical billers have to generate claims based on this information, verify the accuracy, and submit these claims to appropriate insurance payers. Now, when it comes to submitting medical claims, several factors need to be considered.
- Accurate information
- Correct medical codes
- Appropriate modifier
- Insurance payer’s guidelines
- Requirements of the payer
- Timely submissions
Once the insurance carrier receives the claim, they can either approve, deny or reject it.
Reasons for claim denials
The medical billing process comes with several reasons for claim denials. Improper medical coding is one of the major reasons behind the insurance payer’s denying the claim. To lower the risk of these errors, providers tend to partner with medical billing outsourcing companies.
Some of the most common reasons behind denials include the following:
Wrong medical code
CPT, ICD-10, & HCPCS Level II are the most commonly used medical coding systems. Even a minor mix-up in digits or alphabets can cause the entire code to change, leading to billing the incorrect code. Using the wrong code in the medical claim can result in the claim being denied or rejected. Therefore, affects the revenues and reimbursement rate of the provider. Using the correct procedure and diagnosis code is essential for proper medical coding.
Commonly used modifiers include modifier 22, modifier 25, modifier 51, modifier 59, etc. Overuse of modifier 22 is one of the most common medical coding errors. Appending an inappropriate modifier can cause the claim to be denied or rejected by the insurance payer.
Documentation is pivotal for medical billing, revenues, and reimbursements. Inaccurate information can also aid in the use of incorrect codes, therefore, claim denials or rejections.
Every insurance payer has a timeline/deadline for submission of the medical claim(s). If the claim is not submitted in the time duration provided by the carrier, the claim can be denied or rejected by them. Late submission of the claims may also cost money to the healthcare practice at its own expense.
Using separate codes for an individual procedure or service is called unbundling. Using separate codes for a procedure may result in increased revenues however, it is a fraudulent practice and considered Medicare abuse.
When the provider uses a more expensive or comprehensive procedure code than the service actually performed, this kind of practice is known as upcoding and is also Medicare abuse.
Incorrect insurance information
Healthcare providers should gather recent and updated insurance information of the patients. In case old information, ID or card is used in a medical claim; payers won’t recognize and may deny the claim. Moreover, manually entering the insurance information may also lead to incorrect information or billing mistakes.
Purpose of outsourced medical billing in the USA
Typically, healthcare providers like to keep medical billing in-house. Although, keeping the billing in-house can put excessive pressure on the administrative staff and may affect the operations along the way! Therefore, outsourcing billing to any top medical billing company can reduce the hassle. By doing so, the in-house team can focus on the healthcare standards and the patients, leaving billing in the hands of the experts.
The major purpose of outsourcing medical billing to the expert(s) is to achieve just that; a smooth functioning, profitable practice. Following are some of the reasons to outsource billing services to healthcare outsourcing companies in the USA.
1. Lower expenses:
With medical billing service providers like U Control Billing (offering outsourced medical billing services), you don’t have to worry about fixed costs. Your billing costs will depend on your monthly receipts, meaning if your production dips, so will your billing cost. At U Control Billing, we only get paid when you get paid.
Therefore, by outsourcing your medical billing services to U Control Billing you will have to bear lesser expenses than in-house billing.
2. Faster payments:
Outsourced billing service companies ensure timely submissions and are quick to respond to any rejections or denials. The team of experts immediately handles the rejection or re-bill/resubmission after correcting any previous errors. This ultimately results in the providers getting reimbursed properly, timely, and faster.
3. Lower risk of errors:
Medical billing outsourced services companies like U Control Billing have a team of experts and professional billers on board to handle all the billing processes. These specialists are well familiar with medical codes and guidelines and are up-to-date with all the recent changes. Therefore, they ensure error-free medical claim submission.
4. Decreased stress on the in-house employees:
Medical billing is not just about preparing and submitting a claim; it involves error correction, denial management, follow-ups, etc. With a complex and time-consuming process like medical billing being handled by the experts, the in-house team will have lesser stress. They can focus more on providing a safe environment and treatment to the patients, promoting satisfaction and trust among them.
5. More focus on the patients:
The field of medicine is itself quite complicated, and being through all of that just to end up handling paperwork isn’t the goal. However, by outsourcing a major chunk of your administrative tasks, you can focus more and spend more time on treating the patients. Providing them safe care is the primary and ultimate goal of medical practice.
6. Being up-to-date with the changes in coding and guidelines:
The healthcare industry is ever-changing! With new advanced technology treatment also comes changes in codes and coding guidelines. Medical codes or guidelines are updated annually, and failing to keep up with the changes can cost healthcare practice revenues. Therefore, on top of handling billing, collections, denial management, follow-ups, and insurance payers, the in-house team also needs to be up-to-date with everything.
However, by outsourcing your billing services, you can relieve your team with this complex task so they can focus on the patients. The top largest medical billing companies in the USA are the “industry experts.” These professionals are always on top of everything, plus they are quick to adapt to new changes. Hence, you get more time with your patients without worrying or stressing about the revenues or medical billing process.
7. Medical Credentialing:
U Control Billing, along with offering high-quality medical billing services, also offers medical credentialling services. Simply presenting you with an easier and more profitable solution for your administrative work burden. Outsourcing medical credentialing comes with several benefits as well; your in-house team doesn’t have to worry about that either. Being your one-stop solution!
8. Higher reimbursement rate:
Unpaid medical claims or denials can cost the healthcare practice money, lost payments, and, therefore, lesser revenues. However, with outsourced billing services, the team of experts reduces the risk of errors and promptly deals with claim denials and follow-ups. Doing so helps your healthcare practice gain a higher reimbursement rate.
The Medical Billing Process:
The medical billing process comprises two types; front-end and back-end. The entire process can be quite time-consuming but critical to be executed properly.
Front-end Medical Billing process:
The front-end medical billing process phase starts before the patient-physician interaction takes place. It involves the following steps:
- Patient’s pre-registration
- Patient’s registration
- Insurance eligibility verification
- Informing the financial responsibility
- Superbill generation
- Checking out
Back-end medical billing process:
This stage particularly involves medical billers gathering information from the physician(s) and translating it into corresponding codes. Back-end medical billing process involves:
- Charge entry; services performed and why were the services performed; confirmation of the receipts.
- Generating the medical claim; involves the use of CPT, ICD-10, or HCPCS Level II codes to translate the information.
- Claim to scrub; ensuring whether the information (codes) present in the claim is provided and accurate.
- Claim forms; CMS 1500 and UB-04 are the two most commonly used claim forms.
- Submitting the claim; after everything, the claim is submitted to the accurate payer directly. This is usually done electronically. However, the software must comprise HIPAA standards.
- Tracking the claim; after submission, begins checking and tracking the claim. In this process, the payers also review the claim based on which approval, denial, or rejection is decided.
- Patient’s statement generation; on approval, the patient’s copayment statement is prepared.
- Denial management; in case of denial, it should be reviewed and resubmitted by the provider after corrections are made.
Medical Billing Services at U Control Billing:
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. Which company is the best for medical billing?
U Control Billing is a well-reputed medical billing outsourced services company offering several different services at an affordable price. With U Control Billing you get,
- Higher reimbursements
- The lesser risk of errors
- Uninterrupted service
- Billing in 24 hours
2. What is a medical billing agency?
Medical billing companies offer outsourced billing services for healthcare organizations so physicians can focus on providing patient care. Administrative tasks can be quite a burden and are time-consuming. However, these companies ensure that proper medical billing is being done.
3. What are the three types of medical billing systems?
The three types of medical billing systems include:
- Closed system; transfer isn’t allowed (EMRs)
- Open system; transfer is allowed (EHRs)
- Isolated system; removed from the healthcare practice entirely, personal health records (PHRs)
4. What are the two most common types of medical billing?
In healthcare, professional medical billing and institutional medical billing are the two most common types of medical 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.