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Credit Claim Appeals: Strategies And Insights From Kansas Attorneys – Medical billing plays a crucial role in healthcare. Read about smart strategies for reviewing and improving the medical billing process for your patients.
Healthcare providers are usually more passionate about improving and saving lives than accounting. But revenue streams are critical to success, and health systems and providers must prioritize timely and accurate billing.
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A successful billing process starts with the right data. In fact, Rectangle Health’s 2021 Healthcare Payment Experience Report found that consumers across all income brackets are having some trouble paying their bills — in part because they’ve had trouble getting the information they need to pay. On a positive note, you can take simple steps to improve your billing, billing, and collections process. In this guide, you’ll learn strategies to help streamline workflow, ensure compliance, increase revenue, and improve the patient experience.
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First, let’s go over the basics. Medical billing and coding is the process of submitting patient information from medical records, often called a “superbill,” to insurance companies or third parties for payment. The healthcare industry, government, and patients depend on healthcare systems and practices to record, record, and track each patient’s account so that patients are properly billed for the services they receive.
Claims processing refers to a series of steps that document any billing activities throughout the patient journey from registration through treatment and follow-up. Successful claims processing is a collaborative effort that may include the following team members.
When a patient calls your office for a new appointment, the scheduler gathers basic information to determine if insurance will cover the office visit.
Upon check-in, new and existing patients present their insurance and government ID cards. They then fill out paperwork to update their demographic information. This process is important because accurate patient information can help prevent denied claims. When a patient checks out, the front office staff begins the revenue cycle by collecting fees or other out-of-pocket costs.
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After the patient completes the initial paperwork, they have an office visit, procedure, or test. During an appointment, the physician or health care provider documents all billing services using a bill or digitally annotates the visit through an electronic health record (EHR).
After a patient’s appointment, a medical coder retrieves their chart or EHR. Coders translate providers’ notes about services into quantifiable codes. Codes vary based on services offered and level of care.
The coder then sends the coded record to the biller, who enters the information into the claim form manually or using billing software. When completed, the biller forwards the claim to the payer or settlement center for reimbursement.
Following each step in the claims payment process can ensure timely payments, improve the patient experience, and reduce the risk of healthcare fraud. Often times, health systems and providers can improve the payment process. Here are some ways you can streamline and improve your revenue cycle management.
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Today, patients can be more informed than ever. Whenever possible, you can inform patients about the cost of services before receiving treatment, which can build trust and transparency.
Traditionally, superbill was the only link between scheduling and enrollment, clinicians, coders, and billers. A great tool for the provider for billing purposes, it also provides information on follow-up planning and patient billing information. In many offices, the electronic health record (EHR) has replaced the superbill.
These records work well, but interpreting medical bills can be difficult. While it may be easier for providers to check boxes next to billing events, they may overlook the details necessary to support the necessary procedures. If the documentation does not match the charges or any information is unclear, the biller can clarify the unclear language with the clinic.
You can improve efficiency by making it easier for billers to verify proof codes. In small offices, the office manager can facilitate back-and-forth communication between clinicians and billers. Busy practices can support text messaging or priority email to help billers quickly reach their designated providers or assistants.
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When you file a claim with an insurance company, you will need to verify the correct billing format, add the appropriate modifiers, and submit all required documents with each claim. In most offices, employees submit claims using billing software. Learning how to use the software can be critical to successful billing and claim denial prevention.
If everything goes smoothly, insurers will pay claims without much follow-up time. Here are some strategies that can help improve those odds.
A medical coder’s job is to analyze data. Every procedure performed in a medical setting has a specific code assigned to it. Coding professionals must code correctly to ensure accurate billing and maximum reimbursement to the physician or facility. To do this, employees must stay current on coding guidelines, including the ever-changing procedure codes defined by the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS).
Before denying a claim, the third-party payer or insurance company will often give the provider an opportunity to change the claim. Consider developing a process for reviewing and resubmitting claims to help reduce costs and encourage faster payment.
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Above all, don’t be afraid to complain! If something goes wrong during this process and the payer doesn’t pay the wrong amount, consider filing a complaint. You can improve the outcome of complaints with two main strategies:
If the payer is repeatedly late, consider a complaint against a timely payment. Timely payment rules define the amount of time a payer must pay a claim after receiving payment. These laws vary from state to state, so check the law that applies to your provider. If the payer does not pay within the specified period, the law usually requires the payment of additional interest, which is calculated for each day of delay in payment.
According to the American Hospital Association (AHA), bad debt consists of services that hospitals expected but did not receive payment for. In 2020, uncompensated care in community hospitals was $42.67 billion. One way to prevent bad credit is to use the strategies below to encourage patients to pay their bills before they go to collections.
A billing portal integrated into an easy-to-manage patient portal can be part of a broader patient engagement strategy. But despite the demand for online billing access, only 21 percent of patients in group practices and 25 percent of patients in private practices surveyed in a 2021 PYMNTS survey paid medical bills on the provider’s website. Online payment portals are more likely to convert payments than paper bills because they meet patients where they are.
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To achieve success, work with an expert to design your portal from the patient’s perspective, and remember that an effective billing and collection strategy prioritizes the patient’s needs over the biller’s. For starters, cost transparency goes a long way. According to The Payment Cure: How Improving the Billing Experience Impacts Patient Loyalty, a joint report by PYMNTS and published in September 2021:
Over the past decade, healthcare has shifted from a strict fee-for-service model to providing integrated services and value-based care. This shift to patient-centered models reflects the desire of today’s healthcare consumers to take responsibility for their own health.
Because of health care plans, some patients can avoid insurance companies altogether and pay for services, tests, and procedures on their own terms.
Additionally, some health systems and practices may work with financing partners to offer flexible payment options to their patients. When patients use a credit card as a payment option, for example, immediate benefits include:
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Medical billing and collections are an important part of the healthcare industry. Hospitals, doctors, and clinics depend on the process of getting paid, tracking the patient’s medical experience, and the practices continue to be meaningless. Medical billers are an integral part of the medical practice. They interact with providers, patients, and payers on a daily basis and are responsible for correctly billing insurance companies, the government, and patients. Empower your billing staff by implementing the above strategies, which can improve your medical billing process and help patients get the care and treatment they need.
Pamela Cagle is a freelance writer based in Birmingham, Alabama. She uses her background in healthcare and patient education to create useful content that is informative, meaningful and easy to understand.
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