Evaluate Your Medical Billing Process To Improve Your Payment Collections

The financial health of a practice depends heavily on the working of its medical billing department, where billers need to ensure that accurate insurance claims are created and collections maximized. To maintain a steady growth of the practice, you should evaluate the billing process that will also result in a productive billing team.

Following are seven standard steps of evaluation that should be applied to assess the functioning of your medical billing process. However, the process is subject to change depending on the specialty of the practice.

7 Steps of Medical Billing Service

It is necessary that every process of the medical billing department should work accurately, according to the designed workflow to avoid financial discrepancies and loss. The best approach to increase your revenue is to collect your payments at-time-of-service. The first four steps of the billing process should be completed before the patient is taken to the physician or medical assistant for clinical exam.

1. Scheduling an appointment

This is the first point of interaction between the practice and patients that occurs mostly over the telephone. The front-desk staff should be adept in asking the right questions in a polite manner. The staff should also ensure that the patient has correct information about the physician and practice location.

2. Enter correct demographic details

The demographic of the patient are most important for billing purpose. Make sure to double check information with the patient, while entering the details in your EHR system. Mandatory details - first and last names, date of birth, location, contact details - are used to create charge that is sent to the medical billing department. While there are certain mandatory details like ethnicity, race and preferred language that are required for Meaningful Use reporting.

3. Verify insurance details

Although a patient can be scheduled without insurance details, but it's preferable to take patient's insurance details at time of appointment. On single click you can verify patient's insurance details and coverage plan through your EHR. This will save time and inconvenience at time of billing and enable the staff to determine if the patient is covered for the physician's specialty or particular medical procedure.

4. Collect payment at time of check-in

Make sure that the front-desk staff collects maximum copays and deductibles at time of patient check-in. The chances of being paid are highest at time of check-in and before patients are sent to the exam room. The remaining three steps will be completed after the patient has been given the clinical service by the physician.

5. Be sure about codes

While creating claims make sure the codes are entered correctly against the procedures and diagnosis mentioned in the e-super bill. Large numbers of claims are denied or rejected due to inaccurate CPT (procedure) and ICD (diagnosis) codes. Using Practice Management software can dramatically reduce the number of inaccurate claims, as codes are electronically generated in the claim.

6. Timely claim submissions ensure payments

Make sure that claims are submitted to the insurance provider on time. Clear your backlog by end of every week, else the payments will be delayed or not made if the claims are submitted 90 days after the date of service provided.

7. Timely follow-up

In case of denials or rejections, create accurate claims and submit them without wasting any time, as delay in submission may result in unpaid claims. Similarly, patients who fail to make payments on time should be reminded through calls and e-mails about their responsibilities. Medical billing is a complex process in a healthcare facility of every size. Providers should have an effective workflow and trained staff to take the bull by its horn.