Lessons learnt in Medical Billing from 2015 to Improve on in 2016

Health providers have not always been meticulous when it comes to patients billing, and have suffered reimbursement setbacks. Added to this, were wrongly coded claims, no timely follow-ups with denial claims and A/R billing. However, with the changing healthcare reforms, CMS rules and regulations, and the ACA act, popularly known as the Obamacare Act, physicians and healthcare providers will need to be much more vigilante. Here’s how healthcare providers can learn from the lessons of the past 2015 to bring in greater stability and improve their Revenue Cycle Management in 2016.

  • Upgrade Technology/ integrate EHR/EMR systems: One of the first things required is to invest in an EHR/EMR system (Electronic Health Records or Electronic Medical records system). Without this in place, healthcare providers may lose a lot in terms of reimbursement with respect to patients who are under Medicare billing and Meaningful use. Moreover, with respect to new payment models that require sharing or referral based payment, under the ACA, and which many insurer vendors are demanding, will require records now being all digitized
  • Staff training: Front office was not trained for verification and eligibility of insurance coverage. Front office and Medical billers will now be required to be trained in many of the new systems- verification and eligibility of the patient’s insurance coverage is a must, as this helps understand if the procedures required will be covered under Medicare or not or will out of pocket expenses be required. Billers need to verify this to avoid increased denial claims
  • Medical Billing Software: This is very essential to have, which could be integrated with any practice management software. It can help streamline your entire billing process, track bills that are due, track patients who need to make payments and even automate late fees. This will help increase your collection on one side and help health providers focus more on patient health. Know when to outsource your medical billing, to avoid getting entangled in the rules and regulations and healthcare reform and payment model upgrades.
  • Vigilance when processing ICD-10 coding Forms: The switch from ICD-9 to ICD-10coding has brought in not just an increase in number of codes but also specifications like laterality. Unlike in ICD-9 coding system, codes and modifiers were used as per ones wishes, in ICD-10 coding, coders need to be very specific to help the billing department process the claims. Hence medical billers need to be extra vigilant. When coders err, billers will need to recheck the codes alongside the documentation provided, especially during resubmission of denial claims
  • Documentation:  This is now a prerequisite that is required from most healthcare providers. Billers need to ensure that documentation of procedures and check-ups are noted down to the finest details. This is required to cut down claim denials, which could be a long process, and thereby streamline the Revenue Cycle Management Process.

Healthcare reforms and CMS rules and regulations have made it tough and allow no laxity in the claim process.  To make Medical billing a success in 2016, a mix of technology and training, and vigilance and monitoring, will need to streamline processes to integrate the rules and regulations and adapt to the Value based performance payment system for an effective Revenue Cycle Management process.