Almost 80% of medical bills contain errors, which lead to delays/denials of the payments. For the providers, medical billing is not just about submitting claims but also about making sure that they have financial stability while taking care of the patient. Nevertheless, with continual changes in rules and regulations, coding, and other insurance policies, it becomes hard to manage in-house medical billing.
This is where and when the medical billing services step in. By outsourcing these services to an expert, the professionals can focus on operations, reduce errors, and improve reimbursements. Now let’s go deep into the prominent services of medical billing and how they are fundamental for the healthcare practitioners to be successful.
1. Patient Eligibility Verification
It feels distressing when you realize that the insurance of the patient was invalid after the treatment. The base of the medical billing process lies in the accuracy of the patient’s information. The nightmare of denied claims, unpaid bills, and loss of revenue is more common than you think. A medical billing service first verifies the patient’s personal details, insurance coverage, and eligibility for the treatment to prevent issues.
- Personal Information Verification: Make sure that the patient’s name, date of birth, address, and contact details are precisely recorded.
- Insurance Verification: Complying with active coverage of the insurance, policy details like policy number, group number, and other specific benefits on the plan, and patient responsibility.
This step helps to reduce delays in the claims process or further denials in the process.
2. Medical Coding
Medical coding is the backbone of the billing process. It modifies diagnoses and treatments into standardized codes for insurance claims. Any error in coding can cause claim denials, incorrect reimbursement, and loss of revenue due to non-compliance. These codes are used accurately to describe diagnoses, treatments, and procedures, ensuring that insurance companies understand what services were provided and can process claims efficiently.
There are different types of codes used:
- ICD-10 Codes: These codes are used to identify diagnoses and medical conditions.
- CPT Codes (Current Procedural Terminology): These codes are used for reporting medical, surgical, and diagnostic services.
- HCPCS Codes (Healthcare Common Procedure Coding System): These codes cover services, supplies, and equipment that are not included in CPT codes.
This matters because it makes sure there is correct reimbursement for all the services that are provided; it helps in reducing claim rejections due to coding errors and compliance with the proper insurance policies and regulations.
3. Charge Entry
Performing a complex procedure but forgetting to bill can lead to a revenue loss forever. Charge entry is the process of recording all the medical billing services into the system. It makes sure that for all the consultations, procedures, diagnostic tests, and treatments provided, the healthcare providers are compensated.
This process involves:
- Documenting Services: Making sure that each service, consultation, diagnostic test, or procedure is listed in the charge entry system.
- Including Modifiers: If necessary, medical billers can adjust codes when multiple or any specialized process is performed and verify that the changes regulate with the payer policies.
If you think, why does it matter? It matters because it prevents the loss of revenue due to overlooked or not billed services. It assures transparency in the medical charges and optimizes reimbursement rates by using the right coding and billing rules.
4. Claims Submission
A claim rejection means weeks or months of payment delays or no payment at all. Speed and accuracy in claims submission are everything. The next step in the billing process after the data is entered or coded is the process of claims submission. Medical billing services ensure that the claims are accurate, clean, and submitted timely to maximize the rate of approval and reduce denials either electronically or via paper. These claims have all the required codes, details of the service given, and the amount that is to be reimbursed by the insurance company.
- Electronic Claims Submission: The medical billing services use electronic health records (EHR) systems or electronic data interchange (EDI) to submit claims to the insurance company, as it is faster and more efficient and speeds up the process.
- Paper Claims Submission: Sometimes, claims are submitted via paper if electronic submission is not an option. Paper claims take longer to process and may be more prone to errors.
It is important to submit the claims accurately and on time for the healthcare providers as it speeds up the reimbursement process, minimizes administrative workloads, and ensures compliance with the requirements specified by the payer.
5. Insurance Follow-Up
Ever wondered why it takes forever for the claims to get processed? Without the proper follow-up, the insurer may take time to pay or may never pay at all. Medical billing doesn’t stop just after the submission of the claim. The risk of losing the revenue that they are rightfully owed increases for the healthcare providers if active and proper follow-up is not done.
- Tracking Claims: Billing services monitor the progress of each claim, ensuring that it moves through the approval process without unnecessary delays.
- Handling Denied Claims: The medical billing team examines the reason when the claim is denied so that the correct action can be taken. This includes resubmitting the claim with correct information, appealing the denial, or clarifying any misunderstanding with the insurance provider.
- Appealing Denied Claims: Medical billing services initiate an appeal process if the claim gets denied. They review the denial reason and work with insurance companies to resolve issues and ensure that the provider is reimbursed.
Effective follow-up is important so that maximum reimbursement is done and all the claims are properly paid. It also helps in reducing outstanding account receivables that are improving the cash flow. Outsourcing follow-up experts can save a good amount of time and resources.
6. Patient Billing and Statements
Patients are more apt to pay their bills on time if they understand them clearly and accurately. Medical billing services help in generating clear and accurate patient statements, which helps in eliminating confusion, reducing disputes, and ensuring transparency in billing.
- Generating Statements: The billing service generates patient statements that itemize the services rendered, the insurance payments received, and the amount that the patient is responsible for.
- Payment Plans: For patients who are unable to pay the full amount at once, medical billing services assist in setting up payment plans to make it easier for patients to manage the bills for the patient who is not able to make the entire payment at once. They address all the queries related to their bills, insurance coverage, and financial responsibility.
Good communication with patients is important as it improves the satisfaction of the patient regarding transparent billing and increases collection by offering flexible solutions for making payment on time.
7. Accounts Receivable (AR) Management
Unpaid claims = lost revenue. Revenue not being collected is the main reason for financial loss for healthcare providers. Managing account receivable (AR) is important to make sure prompt payment for the services by the healthcare providers is done. Medical billing services promptly track and manage the outstanding payments, preventing revenue leaks.
- Aging Reports: Medical billing services generate aging reports to track claims that are unpaid for a longer period and identify any claims that have to be followed up on.
- Collections: They work and coordinate with the agencies and the patients to settle and collect the outstanding amount to reduce the issues related to collections.
The aim of accounts receivable management is to improve the cash flow by significantly reducing the outstanding payments. They make timely collections from the claims that become uncollectable and reduce the financial stress for the healthcare providers.
8. Compliance and Regulatory Adherence
Billing errors just don’t lead to financial downfall–they can cause legal troubles. Medical billing services ensure compliance with healthcare laws and regulations, protecting healthcare providers from penalties. They make sure that the providers comply with industry regulations and patient privacy.
- HIPAA Compliance: Billing services must ensure that all patient information is handled securely and in compliance with the Health Insurance Portability and Accountability Act (HIPAA), which sets standards for the privacy and security of health information.
- Medicare and Medicaid Regulations: Billing services must ensure that claims submitted to government insurance programs like Medicare and Medicaid are in compliance with specific program rules, as these programs have strict requirements.
- Coding Compliance: Medical billing services must stay up-to-date on the latest coding changes, including ICD-10, CPT, and HCPCS codes, to avoid penalties for incorrect coding or billing.
This ensures billing integrity and reduces fraud risk. It helps in avoiding legal complications and regulatory fines.
9. Reporting and Analytics
How will you get to know if your billing process is working efficiently or not? Medical billing services provide informational reports to help healthcare providers improve their financial operations.
- Revenue Cycle Reports: These reports help healthcare practitioners understand the time it takes for the claims to be processed, identify denial trends, and evaluate the financial health of their practice.
- Financial Performance Metrics: Medical billing services often provide key performance indicators (KPIs) to help practices improve their efficiency and profitability.
Conclusion
A medical billing service is like the financial lifeline of any healthcare practice. When it’s done right, it makes sure that the payments to the providers are done timely and accurately so they can focus on the care of the patient. From verifying the details of the patient to coding, submission of claims, and compliance, and every step plays an important role in creating smooth revenue cycle management.
By outsourcing medical billing to experts, healthcare providers can focus on:
- Delivering excellent patient care while ensuring that their financial operations run smoothly.
- Reduce the delay in payments and claim denials.
- Improve cash flow and revenue
- Compliance with healthcare regulations
If you’re looking for a way to optimize your billing process while freeing up time to focus on patients, partnering with an expert medical billing service is the only solution you need to transform your practice’s financial health.
Partner with expert medical billing professionals and watch your practice flourish.