Small practice owners or solo providers generally manage medical billing all by themselves. They juggle between patient care and administrative activities of medical billing. As medical billing requires medical specialty-wise billing and coding expertise, most of the time, providers lose a lot of money due to denied claims. They just focus on submitting claims earliest and are happy to receive whatever payments insurance carriers are making. In this article, we shared 5 ways small practices can maximize their collections with the main focus on patient care.
Most of the claims get rejected due to inaccurate patient demographics and insurance information. Standardize your information gathering process and collect information like name, address, phone number, copy of the photo ID, and other details. Verify the accuracy of patient and insurance information using patient portals; billing software; or clearinghouse software. In case of any changes in the information, update in billing system asap.
Generally, patient information like zip code keeps on changing as patients might have relocated. Also, stay in touch with your patients and request them to notify your practice about any changes in insurance or patient information.
You will be surprised to know that out of all claims submitted by small practices, almost 40 percent of them contain errors. Either rendering provider details might be incorrect or billing information or missing reference number or an inaccurate number of units. It's always easier when you fill all fields correctly the first time. When you submit clean claims the first time, you will receive reimbursement quickly.
In case the claim got rejected or denied, you have to rework the claim, and if required need to contact the insurance carrier, resulting in a waste of time and delayed payments. Try to submit insurance claims as earliest as possible but don’t submit them if you are not sure about any field in the insurance claim form.
It’s really crucial to educate your patients on planned medical treatments and their insurance coverage. Most patients are unaware of co-payments or deductibles and insurance coverage for all processes. Due to changes in market conditions, most patients are buying High Deductible Health Plans (HDHP), leading to high patient responsibility for any medical visit. It’s the responsibility of providers to educate their patients on planned medical activities, insurance coverage, and patient responsibility.
Collecting patient responsibility from a well-informed patient is easier as patients are mentally prepared to make payments at the time of visit. Using simple flyers or banners to convey billing basics to your patients is a good technique to speed up the claims processing. You could also dedicate a special helpline to guide your patients on the payment process. By educating your patients about the insurance process, you avoid being the middle man in the patient-insurance company relationship.
As discussed earlier, most providers doing medical billing all by themselves, are focused only on submitting claims and ignore the explanation of benefits (EOBs)/ electronic remittance advice (ERAs). Every insurance carrier provides detailed payment information for every submitted claim. Single line items from EOBs and ERAs will include payment remarks whether payment is been made or the claim is being denied with remark code.
When you start reading EOBs/ERAs then you can find how many claims are getting denied and what is the most common reason for claim denial. Whether it’s a patient’s insurance coverage or lack of credentialing or wrong use of procedure code/modifier or claim not paid due to unpaid deductibles, reading payment remarks will help you to collect accurate insurance and patient reimbursement.
Use medical billing software to submit claims electronically. There are lots of insurance carriers now, who are not accepting paper claims anymore. There are tons of advantages to submitting electronic claims and you will require medical billing software to do that. Even for small practices, there is a number of medical billing software that is charging on a number of claims submitted. There are various modules of billing software and you can choose based on your practice requirements. If you integrate it properly, medical billing software helps to keep track of all submitted claims and also allows you to resubmit denied and rejected claims efficiently.
As mentioned earlier, medical billing requires billing and coding expertise and consumes a lot of time. In case of any claim gets rejected or denied, contacting insurance carriers and reworking such claims consumes a lot of time. Small practice owners or solo providers might avoid taking assistance from medical billing companies due to high consulting charges but that’s not the case with us.
Medical Billers and Coders is a leading medical billing company providing complete revenue cycle solutions. We assist medical practices to receive accurate reimbursements they deserve and charge only on the collected amount.
We assist medical practices in every aspect of medical billing whether it’s charge entry, payment posting, AR management, denial management, provider enrollment, and credentialing.Back