Top 4 Tips to Add Efficiency to the Medical Claims Billing Process

Streamlined cash flow is undoubtedly crucial for the survival of any medical practice.  And clean claims submission plays a vital role in the overall revenue cycle. Therefore, healthcare providers must understand the fact that effective medical claims processing is a prerequisite for financial health.

With the passage of time, the healthcare industry witnesses constant evolutions in terms of documentation requirements, federal laws, billing rules, and the guidelines of insurance companies. Therefore, medical practitioners find it difficult to keep pace with these changes and face immense challenges to keep their claims process tight. 

As a result the claims denial rate increases, which badly affects the optimization of revenue cycle management. No doubt due to the complications in the medical billing process, claim denials have become a common phenomenon. But if the rate of denied or rejected claims exceeds the specified limits, it pushes a medical practice into an unrecoverable crisis. 

Moreover, medical practitioners don’t have enough time to look after the billing process with their full potential. Because they are wearing too many hats. So they prefer to outsource their claims billing process. It may be best to use a service, as provided by firms such as Ankin Law Office, to aid with the process.

By doing so, they can get rid of the excessive administrative burden and feel free to concentrate on the core aspects of their medical business.  Which increases the satisfaction level of their patients. So when your patients are satisfied, they will also recommend you in their social as well as friend circle.

In addition to this, by outsourcing medical billing services, healthcare providers can save a great amount on the overall operational costs including the recruitment and training of employees, office workspace, purchase, maintenance of software, and overall infrastructure for the claims billing process.  Outsourced billing partners know the fact that medical claims processing is a prerequisite for financial health. Therefore, they made all possible efforts to improve the bottom-line of your medical practice.

Are you looking for innovative strategies to improve the claims billing process? You must consider the following ways to get optimized results.

  1. Accurate/Complete Patient Information

The front desk employees play a crucial role in the entire billing process. Because they are responsible to record basic patient demographic information including the patient’s name, address, date of birth,  insurance eligibility, payer and policy number, etc. Medical billers use this information to prepare medicals claims, which are submitted to get reimbursed.

A slight error in this information can lead to claim denials which affect the efficiency of the claims process drastically. That leads to uninterrupted cash flow. So healthcare providers should hire well-experienced registration staff to avoid these problems. 

It’s worth mentioning here that first desk staff must verify the insurance information with each visit. Because Insurance carriers and coverage limits may change due to certain reasons.

  1. Minimizing Coding Errors

No doubt, medical claims processing is a prerequisite for financial health. And medical coding plays a vital role in the optimization of the claims process.

Coding is a complex procedure that involves the transformation of the following documentation into universal standard codes:

  • Patient’s diagnosis
  • Treatments, medical services, or supplies the patient received
  • Any unusual circumstances or medical condition that affected those treatments and services

Medical billers use these codes to prepare medical claims. It is a complicated procedure that cannot be handled by inexperienced individuals. Because improper handling of medical codes leaves room for mistakes. As a result, the claims denial rate increases, and medical practitioners have to face significant revenue loss. The most common coding errors are included, mismatched, incorrect codes, upcoding, or inaccurate code modifiers.

Therefore healthcare providers must hand over this responsibility to only certified and highly trained medical coders. They should use accurate CPT and HCPCS code modifiers to provide additional information about the medical treatment or procedure performed. If you don’t have access to the professional coders, you can outsource your medical billing services to a reliable third party.

  1. Timely Submission of Clean Claims

We all know that medical claims processing is a prerequisite for financial health. Because the streamlined cash flow mainly depends on the submission of medical claims in a timely manner. So medical billers should submit error-free claims to maximize the reimbursements in a minimum time. A clean claim should meet all of the following requirements:

  • Accurately identifies the patient and health plan subscriber.
  • Lists the date and place of service.
  • Clearly describe medical services and treatments a patient received.

It is the responsibility of medical billers that they should cross-check the provided information to ensure clean claims submission.

  1. Implement an Effective Denial Management System

The role of medical billers doesn’t end with the submission of claims. They have to track every single claim until medical practitioners get paid. In the case of rejected or denied medical claims, they first analyze the root causes of claim denials.

The most common causes of claim denials are incorrect or incomplete patient information, coding errors, submission of duplicated claims, etc,.  After root causes analysis, they rectify the errors and appeal the medical claims on a priority basis. This systematic procedure optimizes the revenue cycle and healthcare providers enjoy a streamlined cash flow.

Billing experts not only effectively manage the denied claims, but they also propose medical billing solutions to prevent such occurrences in the future.  Hence we can say that medical claims processing is a prerequisite for financial health

Medcare MSO is a top-notch medical billing company in the United States. Which provides extensive claims billing services to meet your financial needs.