{"id":15503,"date":"2022-06-27T09:07:01","date_gmt":"2022-06-27T09:07:01","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=15503"},"modified":"2026-05-11T14:48:46","modified_gmt":"2026-05-11T14:48:46","slug":"practice-management-guidelines-to-improve-practice-collections","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/practice-management-guidelines-to-improve-practice-collections\/","title":{"rendered":"Practice Management Guidelines to Improve Practice Collections"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">Receiving accurate insurance reimbursement for delivered services is always been a challenge for healthcare providers. Practice owners spend most of their time and energy on doing administrative tasks of medical billing to receive sufficient insurance reimbursements to cover overhead expenses and provide quality care. But often they make this task even harder by doing sloppy coding and billing which leads to delayed or incorrect reimbursements from insurance carriers. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">Providers can follow some practice management guidelines to improve coding and billing accuracy. It will help in reducing denials and rejections, ultimately helping to improve practice collections. These guidelines will not only help to receive timely and accurate reimbursements but also avoid the chances of external payer coding or billing audits.\u00a0<\/span><\/p>\n<h2>Practice Management Guidelines to Improve Practice Collections<\/h2>\n<h3><span style=\"font-weight: 400;\">Front Office Issues Leading to Claim Denials\u00a0<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Most practices only focus on submitting claims quickly but no one pays attention to payment posting. Practice owners must generate reports and find out how many claims are submitted and how many are actually paid. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">Then focus on claims that are denied, or rejected and payment status is mentioned as pending. Basic practice management guidelines would be identifying the most common reasons for claim denials and finding ways to eliminate them. The most common front office-related denial reasons are as follows:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">No patient eligibility check is conducted (no updated insurance coverage report available)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Absence of prior authorization\/precertification for planned services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Patients\u2019 insurance coverage is expired<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Patients\u2019 coordination of benefits (COB) is missing\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Clinical notes are not concise, detailed, or specific<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Diagnosis lacking specificity<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Your front office is where the revenue cycle begins. Your front desk staff must have an insurance coverage report for every patient visit and must be qualified enough to understand the insurance coverage report. Practices also make the following mistakes while making clinical notes leading to claim denials:\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The date of service doesn\u2019t meet frequency limits<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Time spent with the patient for time-based services is not documented<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The note is not signed<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The billing provider\u2019s and service provider\u2019s names don\u2019t match<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The note doesn\u2019t support the CPT codes reported for it<\/span><\/li>\n<\/ul>\n<h3><span style=\"font-weight: 400;\">Back Office Issues Leading to Claim Denials<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Your back office handles medical coding, communication with insurance carriers, and other activities. The most common issues back offices frequently deal with include the following:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">CPT codes are inconsistent with the place of service<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The patient has reached the benefit maximum for the time period<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Submitting duplicate claims\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Procedure\/modification combinations are incompatible<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Referral(s) are not listed on the claim<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">When such issues occur, it\u2019s the back office\u2019s responsibility to rectify them as quickly as possible, and then share the feedback with the source of the errors. You might lose thousands of dollars for an external payer audit due to such back-office mistakes.\u00a0 Some of the recommendations include the following:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Conduct internal monitoring and periodic billing and coding audits<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Implement compliance and practice standards by developing written standards and procedures<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Conduct periodic training and education on the standards and procedures for all your staff<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Investigate violations or allegations of violations and disclose any incidents to the appropriate government entity<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Develop open lines of communication such as staff meetings on how to avoid erroneous or fraudulent conduct<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">You can use the internal audit feedback to learn, protect your practice, and make sure that you\u2019re improving your practice collections and reducing compliance risk.<\/span><\/p>\n<p><span style=\"font-weight: 400;\"><a href=\"https:\/\/www.medicalbillersandcoders.com\/medical-billing-outsourcing.aspx\">Medical billing and coding<\/a> require manpower with the desired skill set and <a href=\"https:\/\/www.medicalbillersandcoders.com\/specialty-index.aspx\">medical specialty-specific billing and coding experience<\/a>.\u00a0 Hiring and constantly training, skilled manpower is the right solution to improve practice collections while remaining compliant with payer billing and reimbursement guidelines. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">In case of a lack of skilled manpower or to reduce high payroll costs, you can outsource your medical billing operations to a medical billing company. <\/span><b>Medical Billers and Coders (MBC)<\/b> is a leading <a href=\"https:\/\/www.cms.gov\/medicare-coverage-database\/view\/article.aspx?articleId=55784&amp;ver=5&amp;Cntrctr=All&amp;UpdatePeriod=758&amp;bc=AQAAEAAAAAAAAA%3D%3D&amp;\">revenue cycle<\/a> company providing complete medical billing services.<\/p>\n<p><span style=\"font-weight: 400;\">To learn more about our medical billing and coding services, you can contact us at <\/span><a href=\"mailto:info@medicalbillersandcoders.com\"><span style=\"font-weight: 400;\">info@medicalbillersandcoders.com<\/span><\/a><span style=\"font-weight: 400;\"> \/ <a href=\"tel: 888-357-3226\">888-357-3226.<\/a><\/span><\/p>\n<h2>FAQs<\/h2>\n<h3>1. Why do many healthcare providers struggle with accurate insurance reimbursements?<\/h3>\n<p>Healthcare providers often face challenges due to sloppy coding, billing errors, and administrative tasks that delay or reduce reimbursements from insurance carriers.<\/p>\n<h3>2. What are some common reasons for claim denials?<\/h3>\n<p>Common reasons include lack of patient eligibility checks, missing prior authorizations, expired insurance coverage, and improper clinical notes or diagnosis coding.<\/p>\n<h3>3. How can front office staff help prevent claim denials?<\/h3>\n<p>Front office staff should ensure updated insurance reports for every visit, verify coverage, and ensure clinical notes are specific, accurate, and signed.<\/p>\n<h3>4. What back office issues lead to claim denials?<\/h3>\n<p>Issues like inconsistent CPT codes, duplicate claims, incompatible procedure combinations, and missing referrals can result in claim denials.<\/p>\n<h3>5. How can outsourcing medical billing improve practice collections?<\/h3>\n<p>Outsourcing medical billing to experienced professionals ensures proper coding and timely claims submission, reducing errors and improving overall reimbursements.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Receiving accurate insurance reimbursement for delivered services is always been a challenge for healthcare providers. Practice owners spend most of their time and energy on doing administrative tasks of medical billing to receive sufficient insurance reimbursements to cover overhead expenses and provide quality care. But often they make this task even harder by doing sloppy [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":15504,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[3503,3504,3497,3502,3499,3060,3507,162,3505,3506,3501,3500],"class_list":["post-15503","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medical-billing-services","tag-basic-practice-management-guidelines","tag-billing-and-coding-audits","tag-complete-medical-billing-services","tag-improve-coding-and-billing-accuracy","tag-improve-practice-collections","tag-improving-your-practice-collections","tag-leading-revenue-cycle-company","tag-medical-billing-and-coding-services","tag-medical-specialty-specific-billing-and-coding-experience","tag-payer-billing-and-reimbursement-guidelines","tag-practice-management-guidelines","tag-receiving-accurate-insurance-reimbursement"],"yoast_head":"<!-- This site is optimized with the Yoast SEO 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