Health InsuranceMedical Billing ServicesMedical CodingPractice ManagementRevenue Cycle Management (RCM)

What are the most effective ways to streamline the Medical Reimbursement problems?

With the ever-increasing cost of health care and stringent governmental provisions, it is a time that medical practitioners think of streamlining the process of medical reimbursements to suffice in the competitive environment. All physicians need to realize that their own practice is the asset that requires attention and constant improvement. There need is a mechanism in place that works towards maximizing the practice revenue and contains operating costs of the clinic. Here are some useful tips through which you can streamline the process of medical reimbursement:

Tip I: Recruiting Qualified Staff

Recruiting the staff for your practice can make it or break it. Hiring someone qualified to do the job can multiply productivity and help the practice grow immensely. The vacancy advertisement must enlist all the necessary qualifications and qualities that the employee must possess. This acts as a good filter and lets you narrow down to the most appropriate candidates. The hiring department must analyze the resume carefully and access if the candidate is fit for your practice. Never hesitate to contact the references listed on the resume. Situational questions can go a long way in testing a candidate’s caliber. Most of all, a practice must never deter from offering a competitive salary to a deserving aspirant.

Tip II: Timely and Accurate Billing

Improving the whole process of medical billing like accurate claim filing, pre-authorization, and electronic billing can streamline the medical reimbursements of your practice a great deal. The front staff needs to acquire the correct insurance information of the patient to avoid delays and errors. They must also file the claims timely. It’s also important that the physicians and his staff maintain a clear chain of communication. The doctor must tell the staff what services he provided and the procedures he executed on the patient so that all of it can be billed by the billing staff. Physicians who work in association with hospitals need to reach an arrangement with the hospital billing staff where they bill the services which the physicians provide in their own practice.

Tip III: Spot on Coding

CPT codes help in determining exactly which services were provided to the patient, while ICD 9 codes describe the reason for providing those services. The use of modifiers is advised when the services explained by CPT codes need to defined further. The coding needs to be highly specific and must include all five digits if need be. The practice needs to go through an internal education exercise for doctors, nurses, and staff so that they are well versed in the use of these codes.

Tip IV: Tackling Reimbursements with Care

The last step towards streamlining your practice’s revenue is to make sure you are paid in full. Explanation of Benefits (EOB) is a document which comes along with the reimbursement check from the payer and is a good tool that can be utilized to obtain knowledge about in how much time are the claims paid, whether the practice charges are approved or not and if any discounts were deducted from the billing charges. You can also review the payment denials mentioned in EOB and work towards reprocessing these claims.

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