Lessons to learn about medical billing from 2016 to improve on in 2017

To err is human; but in the healthcare industry, it can cost a patient all his savings, or can drastically reduce the revenues of a physician. Hence, in all possibilities, the medical billing and coding team must avoid slip-ups or inaccuracies in billing claims that cause denials or rejections. Lessons learnt from 2016 must be improved upon so as to not be repeated in 2017.

In the medical practice, ‘insurance verification’ is the topmost concern of providers of medical services. Lately, Americans have been paying higher premiums along with fewer choices for their healthcare coverage, mainly due to insurance payers backing out of several states. Practices too face a brunt as they need to be aware of which and how much of their services is paid due to decreased incentives, taut payments, reimbursements based on metrics and bundled payments. Hence, it becomes all the more liable on the medical billing professionals to verify insurance coverage of the patient and ensuring that it is active along with a check on procedures/services covered/not covered by insurance providers; an communicate wisely with the patient to make them aware of billing procedures and payments.

The medical billing professionals must not leave any missing information while filing a claim. Very often, the social security number is missing which triggers 61% of initial medical denials. Again, the claimant must be aware of the correct address, contact numbers, name and DoB for precision in billing. Up to 32% of denials occur due to duplicates (billed twice for the same service, beneficiary, provider, encounter, date etc.). It is advisable to not carry this factor in 2017. Delays also occur due to laxity in filing claims after the submission dates allowed by insurance payers. It is advisable to hold financial meetings to regularly review your collections and make a note of the processes that are working and those which aren’t.

For efficiency and effectiveness, it is required that technology is used. As Medicaid and Medicare rules tend to change often, the software’s are updated automatically leaving lesser chances for errors. Usage of business intelligence will be an added advantage in the coming year. Due to data mining and improved medical billing software, specific reports can be generated giving the information required for decision making and improvising, also increasing productivity, and identifying and eliminating payment inaccuracies. It is vital to invest in one.

If your staff has not been trained well in 2016, it is about time to realize that their skills must be upgraded at regular intervals to create awareness of the latest changes in medical insurance policies, appeals and claims processes. Offer incentives to your staff to keep them motivated.

If you haven’t added the USPS service in 2016, its time to add it now. For a small fee, add the ‘address service requested’ while posting physical bills to obtain the new address of the patient from the post office.

Around 20% of a physician’s earning is through patient co-pays. The hospital staff must clearly explain the payment options available to the patient (payment plan, payments on portal through credit/debit cards, deferral, interest only payments etc.) along with being courteous at all times. Also, collecting at the time of service/creating POS collections can increase timely and accurate payments. ‘Patient statements,’ if clearly mention the provider details, services performed, charges, payer adjustments etc. can effectively initiate a response from the patient for apt payments.

Incorrect coding and insufficient documentation leads to errors in medical billing. It is essential that E/M claims are accurate; documents include physician authentication, and the right place of service. Awareness and implementation of specificity in CPT codes, modifiers, and ICD-10 coding can increase revenues to a great extent. Also, CMS has released the ICD-10-CM updates for FY 2017. These are to be used for patient encounters beginning Oct. 2, 2016 to Sep. 30, 2017.

A medical biller must work towards requirements of claims and their follow-up, reduce the number of days for payments, and receive appropriate payments for services provided by the healthcare practitioner, along with understanding insurance rules and regulations. However, outsourcing remains to be viewed as one of the best options for minimizing errors and ensuring accurate and timely claim submission and revenue collections. Medical billing companies efficiently and proactively submit clean claims, streamline processes and reduce denials. Their team is aware of the latest ICD-10 changes, the revised ABN, the HIPAA 5010 medical coding and reporting compliance etc. thereby providing a competitive edge in your medical RCM services.

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