7 Ways to Reduce Revenue Leakage in Medical Billing

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7 Ways to Reduce Revenue Leakage in Medical
Billing

• Revenue Leakage in Medical Billing
• Revenue leakage refers to situations where a
  healthcare provider doesnt receive insurance
  reimbursement for delivered services. In such
  billing situations, accounts receivable remain
  unpaid for too long and eliminate the chances of
  payment recovery, even partially. Healthcare
  practices cannot afford to ignore their revenue
  leakage as its directly affecting their ability
  to smoothly run day-to-day activities.
• The good news is that providers can address many
  of the revenue leakage causes by identifying
  inefficiencies, improving their processes, and
  targeting improvement. In this article, we shared
  7 ways to reduce revenue leakage in medical
  billing, lets discuss them in detail.
• 7 Ways to Reduce Revenue Leakage in Medical
  Billing
• 1. Quickly Submit Claims
• Your billing teams prime responsibility must be
  to submit insurance claims as soon as possible,
  ideally within 24 hours of the patient visit.
  Your billing team should be ready with all
  required details prior patient visit like patient
  demographics, insurance information, insurance
  coverage, patient responsibility, referral
  number, and prior authorization (if any).

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7 Ways to Reduce Revenue Leakage in Medical
Billing

• Once your coding team provides procedure codes
  and modifiers, you can submit claims quickly.
  When you quickly submit insurance claims, it
  offers a lot of benefits like quick insurance
  response, correcting rejected claims, and reduced
  AR days.
• Every insurance company has different timely
  filling limits starting with 3 months up to 12
  months. Ideally, you should not wait for such
  timely filing limits as a claim may get rejected
  at any stage, and once it returns to your desk,
  half the time is gone.
• Familiarize yourself with the best practices that
  ensure timely filing of claims like using billing
  software filing fresh claims daily daily
  checking of benefits verification (including
  prior authorization) and rework on rejected and
  denied claims.

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7 Ways to Reduce Revenue Leakage in Medical
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2. Entering Correct Claim Details Entering
incorrect patient demographics and insurance
information is the prime reason for claim
rejections. Prime reasons for claim rejection
include the incorrect date of birth, name or
spelling, subscriber number, incorrect zip code,
and subscriber information. When the claim is
rejected, its stuck in billing software and it
does not reach the payers system until its been
corrected. To reduce such rejections, you need to
improve the patient registration process. Each
and every patients details need to
be crosschecked to verify their correctness.
There are several ways to crosscheck these
details. You can use the provider portal, or use
clearinghouse services. Some billing software
shares such benefits reports with a single click,
or you can directly call the insurance rep. These
activities will help to bring claim rejections as
low as 5 percent while identifying prior
authorization requirements. 3. Crosschecking
Insurance Coverage Using eligibility and
benefits verification you can reduce your revenue
leakage to a great extent. In the eligibility and
benefits verification process, the billing team
will check the patients eligibility for planned
procedures along with the patients overall
benefits.
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7 Ways to Reduce Revenue Leakage in Medical
Billing
If a patient doesnt have active insurance
coverage then you can communicate with the
patient for alternate insurance. The eligibility
and benefits verification process also helps to
find out prior authorization requirements. Eligib
ility and benefits verification provides you the
assurance that you will get paid for the
delivered services as the patient is having
active coverage. 4. Reduce Coding
Errors Medical coding is the core of revenue
cycle management. Medical coding can be
challenging as coding guidelines get updated
constantly, plus coding guidelines slightly
change as per insurance company and
state. Frequent coding errors include using
incorrect or deleted codes missing modifiers or
combination codes lacking medical
specialty-specific coding experience, and
undercoding. Most practice owners make the
mistake of doing medical coding all by
themselves. In such situations, they tend to use
few procedure codes for all their patient visit.
Such activities will not only attract compliance
issues but also impact the practices revenue in
long term. Its a must condition to have a
certified, experienced medical coder who has done
coding for your medical specialty in your area.
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7 Ways to Reduce Revenue Leakage in Medical
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Such a qualified coder will help you code
accurately and will also use modifiers whenever
applicable. You also need to invest in their
training to ensure that they are updated with
current coding guidelines. 5. Entering Accurate
Diagnosis Codes The diagnosis codes are
important because it provide a common language
for recording, reporting, and monitoring
diseases. The diagnosis codes support the medical
necessity for the service and tell the insurance
companies why the service was performed. It can
be the source of denial if it doesnt show the
medical necessity for the service performed. The
current version of diagnosis codes
i.e., ICD-10 comes with the basic requirement of
using diagnosis codes with the correct level of
specificity. You have to use accurate diagnosis
codes as using codes from the right family is not
enough, and might cause claim denial. To
eliminate such claim denials, healthcare
providers should share accurate diagnosis on
time. Your billing team can cross-verify the
correctness of diagnosis codes as certain billing
software and clearinghouse services also provide
such suggestions.
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7 Ways to Reduce Revenue Leakage in Medical
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6. Comprehensive Denial Management Denial
management is a strategic process that aims to
resolve problems leading to medical claim
denials. Denial management also sets up a process
that mitigates the risk of future denials. Not
working on denial causes is the major reason for
revenue leakage for any healthcare
practice. According to a recent survey report,
the average claim denial rate has increased by 23
percent compared to four years ago. For medical
practices, this means unpaid services, resulting
in lost or delayed revenues, hurting the
financial health tremendously. The
comprehensive denial management process includes
steps like identifying the denial cause
resolving denials monitoring and preventing the
occurrence of the same denials. Your coders,
billers, AR team, and physicians should work
together to identify, resolve, monitor, and
prevent claim denials. 7. Ensure Provider
Credentialing All your physicians must be
medically credentialed to be reimbursed by
insurance companies. Every insurance company
wants you to get credentialed before you start
interacting with the patients. The credentialing
process validates that a physician meets
standards for delivering clinical care.
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7 Ways to Reduce Revenue Leakage in Medical
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The insurance company verifies the physicians
education, license, experience, certifications,
affiliations, malpractice, any adverse clinical
occurrences, and training. The insurance
companies might delay or refuse payments to
physicians who are not credentialed and enrolled
with them. Getting the documents completed on
time ensures that the new nurse or physician
youve employed can start offering services on
the first day. Provider credentialing is not
something to push off as the credentialing time
frame differs by state due to changes in
legislation and credentialing laws. Medical
Billers and Coders (MBC) is a leading medical
billing company providing complete revenue cycle
services. We are confident that the
above-mentioned ways will certainly help to
reduce revenue leakage for your practice. But
you need experienced and skilled billers and
coders to execute such strategies reducing
revenue leakage. Another challenge is to hire,
retain and constantly train such billing team,
involving a lot of investment. You can hire our
medical billing and coding services to eliminate
your revenue leakage. Our customized,
cost-effective, and medical specialty-specific
services ensure that you will earn more
reimbursements while staying compliant with
payer-specific and state-specific guidelines. To
know more about our overall revenue cycle
services, email us at info_at_medicalbillersandcoder
s.com or call us at 888-357-3226.