Most practices are struggling to stay afloat due to shrinking reimbursements and the recent impact of the COVID-19 pandemic. The days of submitting an insurance claim and getting paid within 30 days are long gone. Various payer billing guidelines and reimbursement policies after the end of the Public Health Emergency (PHE) make it really difficult to collect accurate insurance reimbursements.
Providers who want to spend their maximum time on patient care, are unable to do so. Due to increased denials and reduced patient payments, providers are spending more and more time on billing activities. A few tips that will help you to improve your practice collection in 2022.
Tips to Improve Your Practice Collection in 2022
Accurate Patient Data
More than 70 percent of the claims got rejected due to inaccurate patient data and insurance information. The clearinghouse cross-checks patient data and insurance information against the insurance carrier database and in case of any difference, will mark the claim as rejected. When a claim is rejected, you have to correct the information and resubmit the claim. This process consumes time and delays insurance reimbursement.
When a new patient registers, have a checklist of all the documents needed to register in your system. You need to verify patient demographics and insurance details against the payer database. Some billing software provides features for verifying insurance coverage. You can also visit provider portals and check for the accuracy of patient data and insurance coverage.
For the established patient, you don’t take a benefits report for every visit, just ensure a few details like unpaid deductibles, co-payment, number of allowed visits, and requirement of prior authorization. If a patient has another insurance, mark them as primary and secondary and accurately assign coordination of benefits (COB).
Collection of Patient Payments
In the past, it was common practice for practices to overlook patient balances. With insurance carriers covering the majority of payments, practices never focused on patient payments. Patient responsibility increased rapidly due to the growth of high deductible health plans. It’s not uncommon for patients to have deductibles of greater than $1,000, and practices can no longer afford to leave that money on the table.
Start engaging with patients prior to service and not only at the time of service. Conduct eligibility and benefits verification for every patient visit and share cost estimation prior to visit. You can’t send a statement after the appointment and wait for payment.
Your front desk staff must be fully aware of patient coverage and must be well trained to answer any patient questions related to planned services and patient responsibility. An informed patient is more likely to cancel planned services and likely to pay a maximum portion at the time of visit only.
Improving Coding Accuracy
Soon ICD-11 is likely to replace ICD-10 in the medical billing industry. Over 140,000 new codes and procedures were introduced by the transition to ICD-10, so the next transition will bring more. Procedures and tests for detecting or treating COVID-19 will be included in new codes in 2022.
It is also possible to under-code or to up-code procedures that are not very costly, and to omit or exchange codes for procedures that are not very costly, as these factors can affect claims. Most small practice owners try to code and submit claims all by themselves. This may lead to assigning wrong procedure codes as providers tend to use few procedure codes again and again.
It’s always preferential to have a specialty-specific experienced medical coder in your team. Using the same codes and the wrong use of modifiers for better reimbursements could lead to an external payer audit. You can think of outsourcing coding operations as an economic and safe option.
Outsourcing Your Medical Billing
Different billing guidelines, changed payer reimbursement policies, increased payroll costs, and staff training costs could make it really difficult for any practice to collect accurate reimbursements without spending a lot of time and money on RCM operations. Medical Billers and Coders (MBC) is a leading medical billing company providing complete revenue cycle services.
Our specialty-wise medical billing and coding team will ensure accurate collection of patient and payer reimbursements. Our denial analysis and resolution team will work to reduce denied claim percentage below 10.
With quicker and more accurate practice collections, you will be able to focus only on patient care. To learn more about our billing and coding services, contact us at info@medicalbillersandcoders.com/ 888-357-3226
FAQs
1. Why are insurance claims getting rejected more frequently?
Over 70% of claims are rejected due to inaccurate patient data or insurance information, which delays reimbursement and increases administrative work.
2. How can practices avoid insurance claim rejections?
Ensure that patient demographics and insurance details are verified during registration and periodically checked for accuracy through payer portals or billing software.
3. Why is patient payment collection more important now?
With high deductible health plans, patient responsibility for payments has increased, making it essential for practices to collect payments upfront or at the time of service.
4. How can coding accuracy impact reimbursement?
Incorrect coding or using the wrong codes and modifiers can lead to denied claims or audits, so using accurate and updated codes is crucial for proper reimbursement.
5. What are the benefits of outsourcing medical billing and coding?
Outsourcing to experienced billing services ensures quicker reimbursements, accurate coding, and effective denial resolution, allowing providers to focus on patient care.
