Are you aware that over 850 million medical claims are denied annually in the United States due to billing errors. This can be quite horrifying for the financial health of practitioners. For proper reimbursement, accurate claim submission is necessary. However, it adds a multitude of administrative overload on practitioners which can cause harm to patient care.
Thus, hiring an expert medical billing company is fundamental. These professionals have a deep knowledge of complex billing nuances and expertise to tackle them. This ensures proper revenue cycle management for practitioners.
Basic understanding of medical billing
Ensuring proper medical billing for the services rendered by practitioners is fundamental for the financial health of healthcare professionals. It entails the process of submitting and following up on claims with health insurance companies to receive payment for services rendered by healthcare providers.
Some of the key components of medical billing include:
Patient registration: Collecting patient personal and insurance information.
Financial eligibility verification: Checking insurance coverage and limitations.
Prior authorization: For some medical services, specifically the high-cost and high-risk ones, billers need to seek prior approval from insurance companies. It is essentially a cost-control method.
Medical coding: Converting services rendered along with diagnoses into standardized classifications or codes to help ensure fair reimbursement.
Claim submission: Submitting claims to insurance payers.
Payment posting: Recording payments received.
Denial management: Ensuring proper follow-up to identify reasons for denials and promptly fixing the issue to make timely appeals.
Accounts receivable management: This includes implementing effective practices to obtain all due payments.
There are multiple payer specific connotations added to each of these billing procedures and adhering to the same is fundamental for ensuring proper revenue cycle management of practitioners. This is why hiring an expert medical billing company is a must for practitioners.
What are the common challenges faced
All the above-mentioned steps in the billing process carry their own set of challenges. To begin with, ensuring prior authorization success requires billers to submit proper clinical documentation. Some of the most required documents include justification letters, clinical notes, lab reports, patient medical history, and so on. If there is any gap between these documents, there may be discrepancies in justifying the medical necessity of the services rendered. Thus, the request will be rejected.
Further, ensuring proper code usage is absolute to ensure proper reimbursement for the same. Coders are required to identify and assign the correct CPT among other medical codes accordingly based on diagnoses and services rendered. However, the payer's specific guidelines on coding are quite complex in nature, and that poses immense challenges for coders to assign them effectively. Furthermore, these codes are updated annually, which adds a new layer of complexity for coders. Even the slightest errors in coding can lead to inaccurate capturing of value provided by healthcare professionals, which can cause revenue loss.
Additionally, if the claim is delayed or denied, billers must follow-up profusely to identify the root cause of the same. This is important to ensure claims are processed effectively. In simple terms, after finding the cause of denial, billers can make prompt fixes to the issue identified and make timely appeals. This need for constant follow-ups adds to the administrative burden of practitioners.
Furthermore, if there are any gaps in verifying patient insurance eligibility or documenting their personal data, then also chances of delays and denials get high. For example, suppose due to time-pressure there is a discrepancy in identifying the coverage limit offered by the patient’s insurance payer. After rendering the service, biller submits the claim, and finds that it is rejected, because the payer does not cover such services. Such errors can lead to major revenue leaks for practitioners.
Lastly, identifying patient responsibilities like copays and deductible based on payer specific guidelines is a must to ensure proper reimbursement for practitioners. If there is a gap in the same, then it can again cause revenue leaks for practitioners.
This is why hiring expert medical billing services becomes a fundamental need for practitioners. Abiding all these norms can be quite challenging and can even hinder patient care. But these companies ensure excellence in navigating these nuances, which is critical for proper revenue cycle management of practitioners.
Best practices of ensuring effective medical billing
Collect patient demographic data and verify insurance eligibility details before rendering the service.
Applying correct medical codes to properly capture services rendered.
Obtaining necessary approvals before providing services, specifically for high cost, high risk services.
Timely and clean claim submission with proper codes and documentation to increase first-pass acceptance rates.
Following up on unpaid claims regularly to identify root causes and resubmit corrected claims quickly to minimize revenue loss.
Hiring expert medical billing services can also prove to beneficial for practitioners. These experts can help ensure proper management of the end-to-end revenue cycle and thus take off the administrative workload of billing form practitioners.
Optimize medical reimbursement with the help of an outsourced medical billing company
When it comes to hiring the right help, there is no better solution than outsourcing healthcare billing solutions. This is because these companies are not only expert billers, having in-depth understanding of billing norms but are also quite cost effective. For example, medical billing services like SunKnowledge have great experience dealing with client billing software like Brightree, MedEZ, CureMD and so on.
Not only that, but these companies also have great understanding of complex payer specific billing guidelines, which is indicated in their high level of clean claim submission and first pass claim collection rate. Additionally, these companies offer expert virtual assistant services, which is an added bonus. For example, medical billing services help with front desk services like patient appointment queries and handle 50-55 calls per day depending on need. Lastly, all these services are provided at a reduced rate of as low as $7 per hour. This ensures proper cash flow for healthcare practitioners.
If you are also facing issues with maintaining a steady revenue stream in your healthcare practice, then consider an outsourced medical billing company.