Medical Billing Optimizing Revenue Generation

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Medical Billing Optimizing Revenue Generation

On a day to day basis a medical practice is busy with taking care of patients and running the back end operations. The staff is busy scheduling patients, seeing the daily inflow of patients, calling insurance companies to request authorizations or follow up on claims, etc. In such a dynamic and hectic environment it is not uncommon to see mistakes being made that result in the reducing revenue and increasing expenses.

Whether the practice does its billing in house or it outsources this function, mistakes can be avoided by putting processes in place that will help the practice staff be more efficient while optimizing revenue generation for the practice. Following are five recommendations that medical practices can implement in order to improve their day to day processes:

1. Make a copy of patients insurance cards

An office policy must, is to always make photocopies of patients insurance id cards. Insurance cards can be scanned directly into the practices EMR or can be copied and scanned into the EMR system. Insurance ID cards should be copied or scanned on both sides as they provide important information that is required to submit a claim. The practice must educate its patients on bringing in their newest insurance card every time they come for an appointment even if they claim that the information has not changed. There are instances when the patient is not the primary policy holder of the insurance and is not aware of any changes to the insurance policy. Also, employers may change insurance companies or change plans requiring the practice to update the insurance information in its system.

2. Putting in place a system to submit claims on time

Filing medical claims in a timely manner is vital to a medical practice financial success. The sooner a medical claim is filed, the sooner the practice will get paid. Most insurance companies have time frame limits for a practice to submit a claim from the date of service. Claims that are submitted even a day late from the insurance time frame limit requirements will be denied and the practice will not get paid. Claims that are filed outside of the time limit set forth by the insurance companies will not get paid. Insurance companies time filing limits vary from company to company, the medical practice must be aware of the time filing limits of every insurance company the practice files claims with.

3. Reviewing the practices coding practices

Medical coding translates what took place during a patient visit and determine the level of payment that a medical practice will receive. It is important for medical practices to review their coding practices on a regular basis to make sure that the practice is not under-coding or over-coding. The person doing the coding should be the provider diagnosing the patient or a certified professional coder that can translate what was documented during the patient’s visit into the proper diagnosis and procedure codes. When hiring a certified professional coder, medical practitioners should provide detailed encounter documentation so that the coder can assign the correct diagnosis and procedure codes to the visit.

4. Reviewing clearinghouse reports

Most medical practices today submit their medical claims electronically through a clearing house. Clearinghouses provide a report after a claim has been submitted with information regarding the submission. Some claims will pass through the clearinghouse and get submitted directly to the payer while some claims get rejected and are sent back to the sender for review. Reviewing clearing house reports on a daily basis will ensure that those claims that get rejected at the clearinghouse level get reviewed, fixed and re-submitted on a timely manner. Not reviewing clearinghouse rejected claims on time can result in late time filing submissions which result in the practice not getting paid. Some claims that are rejected at the clearinghouse level can be easily fixed and re-submitted.

5. Follow up on claims and obtaining aging reports

Practices must make it a standard operating procedure to run aging reports on a regular basis. Aging reports will help the practice follow up and take action on the outstanding claims that have not been paid. Not following up on aging reports can cost the practice a lot of money. The hectic day to day operations of a medical practice may prevent the staff from regularly checking the status of the practice claims until someone notices that cash flow levels are down. Regularly running aging reports and follow up of the reports will help reduce insurance denials and rejections.

Please visit our medical billing page to learn more about our iClaim services at: Medical Billing Services

We are currently offering a free practice analysis to help medical practitioners determine whether it makes sense to outsource their billing. Gives us a call at 781-454-7406 and schedule your free demo.

At Vitruvian MedPro we work with medical practices of all sizes with any aspect of their revenue cycle management. Besides billing, we can help practices with their coding, account receivables and make sure that practices receive the highest reimbursements from the insurance companies.

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