Tips to Improve Your Practice Collections

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Tips to Improve Your Practice
Collections
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Tips to Improve Your Practice Collections
Medical billing and coding require an in-depth
understanding of billing terminologies,
state-specific billing and coding guidelines,
insurance carrier reimbursement policies, medical
specialty-wise insurance coverage, and many
others. Solo providers or small practice owners
try to submit medical claims on their own. This
might lead to inaccurate use of codes, more
rejected claims, increased accounts receivables
(AR), over/under coding, and chances of external
payer audit. It is always recommended to manage
your revenue cycle operations from billing and
coding experts. If you are managing billing
operations in-house then the following tips will
surely help to improve your practice collections.
Tips to Improve Your Practice Collections 1.
Submitting Clean Claims Healthcare practices
mostly focus on submitting insurance claims
quickly without focusing on error-free claim
submission or clean claim submission. Most of the
time claims get rejected due to demographic
errors and are stuck in billing software and
wont reach the clearinghouse. A useful RCM tip
would be focussing on submitting a clean claim
and entering accurate patient demographics. Focus
on verifying the patient and guarantors name,
ID, gender, date of birth, SSN, address, phone
number, guarantor details, and insurance details.
Always double-check the information at various
claim fields like date of service (DOS), place of
service (POS), rendering provider details, date
of admission (in case of inpatient), prior or
pre-authorization reference number, diagnosis and
procedure codes, modifiers (if needed), and a
number of units provided.
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Tips to Improve Your Practice Collections
2. Always Verify Patient Benefits Whether its a
new patient or an established patient, always
verify patient benefits (or insurance coverage)
prior to patient visit. With most of the patients
recently opting for high deductible plans, there
are chances that planned treatment may not be
covered by an insurance carrier. You can call the
insurance rep and check for the patients
insurance coverage against planned procedure
codes. If the patients healthcare plan is not
covering the services, you have to communicate
with the patient about the cost estimate and the
exact amount of patient responsibility. Your
front desk team can manage patient eligibility
and benefits using a provider portal,
clearinghouse services or simply calling an
insurance carrier. 3. Take Prior-Authorization Th
ere are certain procedures where you need to
inform the insurance carrier and take approval
about a planned treatment called
pre-authorization or prior authorization. In
certain cases, the insurance carrier might
suggest an alternate procedure that might be more
economical and provides similar outcomes. You
must have a list of procedures that requires
prior authorization. Every insurance carrier has
a unique list of procedures that requires prior
authorizations. If you are not sure about which
procedures require prior authorization, simply
call the insurance carrier for every planned
visit and check for prior authorization
requirements.
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Tips to Improve Your Practice Collections
4. Submit Claims Daily The longer you take to
post charges and submit a claim, the longer it
will take to receive reimbursement from the
insurance carrier. Most major medical payers
process claims in just five to seven business
days. Most practices have a timeframe to submit a
claim, ideally, it should be 24 hours. If you
structure your billing activities by collecting
patient demographics, and insurance information,
verifying insurance coverage and using correct
diagnosis and procedure codes then you will be
able to submit clean claims on a daily basis. If
you file claims only once a week, your accounts
receivable (AR) will grow like anything, which
means a bigger backlog to work through that often
results in more billing errors. 5. Post the
Payments Most practices wont keep track of
payments received. Not posting or delaying
payments would keep your AR artificially high and
you could be missing denials. Some providers
dont post the payment regularly as they are
getting EFT payments. It might affect working on
denied and rejected claims as some payers have
strict refiling rules, which limit your time to
appeal a claim from the date of the remit. By
handling remits within one to two days, you can
move the balance to the secondary insurance and
bill that much quicker. Or, you can transfer the
balance that is due from the patient and generate
a statement. It becomes increasingly difficult to
collect payments the longer its been since the
patients visit.
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Tips to Improve Your Practice Collections
6. Double Check Used Codes Double-check your
claims for diagnosis codes, procedure codes, and
modifiers. Using accurate codes will depend not
only on state-specific coding and audit
guidelines but also on medical documents and
physician notes. Common mistake any provider can
make by choosing diagnosis code/s that are
non-billable. Double check should be kept to
ensure that you are not under- or over-coding
services and procedures. 7. Review Explanation
of Benefits An Explanation of Benefits (EOB) or
Electronic Remittance Advice (ERA) is a statement
the insurance carriers send after processing a
claim received from the healthcare provider. The
EOB lists the total charges (amount billed),
allowed amount, non-covered charges, the amount
paid to the provider, and any co-pay,
co-insurance, and deductibles the patient pays.
By reviewing EOBs, you can determine if you need
to perform a more in-depth investigation into a
claim or determine what further actions are
needed. The simplest way to improve your
practice collections is to outsource your medical
billing services to the leading medical billing
company Legion Health Care Solutions. We are
providing complete medical billing and coding
services to healthcare providers of various
medical specialties. Please get in touch with us
in case of any medical billing assistance on
727-475-1834 or email us at info_at_legionhealthcares
olutions.com
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