3 Protections for Your Healthcare Revenue Stream

Healthcare companies and service providers rely on patient billing practices for the revenue cycle, and a hiccup in the medical billing process can tank a companies finances. It goes without saying the field of medical billing has challenges that affect how efficiently billing and collecting happens. Medical billing can be a time-consuming process, and tracking a claim throughout the life cycle comes with its own frustrations. However, without an efficient revenue cycle, your practice won’t be able to run smoothing or make a profit. There are three key areas where billing offices can avoid running into snags with their processes.

Know the Patient’s Information

When your staff first comes in contact with a patient, you have just a few moments to make sure the right groundwork is laid for successful billing practices. Your employees must start collecting information that identifies the patient’s demographic information and basic information concerning contact numbers and mailing addresses. However, the front-end staff needs to accurately record the health insurance information of the patients and follow-up with coverage and approval before services are provided. This is a crucial first step in preventing the denial of a claim. The average rate for industry denial falls between 5-10%, but the number one reason for denial is an eligibility issue. Your office can avoid saddling clients without the ability to pay with a bill for services by checking on the insurance coverage prior to the visit. This means taking care of getting that information the first time any contact is made.

Make Sure the Patient Knows Their Responsibility

After insurance adjustments and payments, medical billing processes move on to collect the remaining (or full) amount for the services provided by the patient. With the rising costs of insurance plans, many people have opted to enroll in high-deductible coverage, making the amount a patient owes much greater. Over the last few years, it has become more difficult to get payments from patients for these higher-than-expected bills. The financial burden is something that all patients encounter, but for many, there are no resources to take care of the bill. If your office experiences delay or outright nonpayment for services, you need to establish a good payment policy but you also need to thoroughly inform patients of their financial responsibility as soon as you are able (and repeatedly). Simplifying your bills can make it easier for patients to understand what they are paying for, and offering numerous ways to make a payment can also make it easier to collect owed amounts.

Verify Coding Practices

Though many practices have implemented ICD-10 coding practices, inaccuracy continues to be a source of headache for billing departments. Some of the more common coding mistakes include the use of the wrong codes or accidentally confusing cores, mismatching the diagnostic and treatment codes, not having enough documentation, having too few or too many digits in the codes, transposing code numbers, and not using updated codes. The burden falls on the unsuspecting patient, as their claim is then denied. Make sure your staff is well-trained but also offer continuing education opportunities for updates on ICD-10 coding. Using an automated claims management process or outsourcing to an agency like Fortis Medical Billing can also make a vast difference in submitting claims and resolving denials. Manual entries create opportunities for error, and a management system can help improve the accuracy and speed of your billing processes. Automation can help increase your revenue because you can receive your reimbursements from rejections or denials much faster. You are also able to get to the bottom for the reasons for denial must faster, which helps you target your corrective measures.

A floundering medical billing practice can severely impact your profitability and hurt your reputation with your patients. Automated systems help eliminate a lot of the processing errors, but making sure your staff works diligently to capture patient information and inform patients of their financial responsibility will help support a stronger, more effective, process.

This article does not necessarily reflect the opinions of the editors or management of EconoTimes