Best Practices in Medical Billing: Steps Nine, Ten, Eleven
Billing and collections. It sounds straight-forward, routine even. Something that is done in thousands of medical practices with qualified professionals. Most physicians themselves have a general understanding of how the billing process works:
- Enter patient information into an EHR / EMR software program.
- Entering CPT and ICD-10 codes from the superbill into the patient’s record.
- Electronically transmit claims to insurance providers.
- Receive an audit report, review/correct errors, resubmit rejected claims.
- Post payments to patient accounts.
- Review each patients account to access which bills have not been paid on time.
- Follow through on delinquent claims, if any by calling insurance providers.
- Repeat steps 1-7 every day.
However, just because a medical biller is performing these steps, it does not mean she/he is fully doing the job of a medical biller. As time goes on, most medical practices realize that there is more involved than just billing patients and collecting money. Some physicians and staff realize there are better ways to perform medical billing, but just don’t know where to start. These “better ways,” or best practices, can make turnaround time for collecting money more efficient, coding more effective and insurance claim approvals increase. But for others, figuring out the “how-to” to improve these items can be confusing and frustrating.
Who should inform me of the best practices in medical billing?
Physicians are very busy people. Not only are they seeing patients, writing up charts, and keeping up-to-date on the latest medical innovations, they also have to run a small business if they are in private practice. Good physicians are always trying to stay on top of the latest medical research and technology to better take care of their patients; they must also use this approach to take better care of their business.
One way to solve the best practices issue is to outsource medical billing to a specialized company. But not all companies are equal in providing medical billing services. Sometimes, companies that are providing medical billing are only going through the steps listed above, routinely, day after day without any kind of feedback to the medical office they are serving.
How then, can a physician’s office stay on top of changing billing information while also learning of best practices to improve the medical billing process? The answer is having an outsourced medical billing company consistently review their medical billing practices and then discussing this review with physicians.
The Ninth and Tenth Steps… and why they are important
Most people could agree than in any profession, reviewing processes and procedures in place to determine if any changes could be made for improvement is a good idea. If a new process saves money, improves efficiency, and increases productivity, these are all beneficial to a practice. The same can be said for medical billing as it deals with the primary cash flow in a medical office. By reviewing processes and procedures in medical billing, improvements for coding and billing insurance companies will reduce the number of bills not paid over 120 days. And which medical practice would ever admit that they like it when bills routinely run over 120 days? None that we have found!
Ultimately, consistently reviewing and implementing process improvements in all the tasks listed above is an essential ninth step for medical billers. How would they do this? First, having procedures in place that they consistently perform. Second, creating a plan to review these procedures, how they are implemented, and when. Third, strategies or ways to make the changes needed, then communicating them to the physician and/or practice manager.
Discussing and reviewing these changes with the physicians is an essential tenth step for qualified outsourced medical billing companies. This type of feedback to physicians will explain what has changed in the industry and recommendations for improvement. These improvements, as noted, usually lead to increased cash flow, reduced billing times, and improved claim acceptance to insurance providers. Discussing this information with physicians and practice managers leads them to make better business decisions and helps them plan for the future of their practice. It also has an additional benefit of strengthening relationships between the outsourced company and internal staff, building trust and goodwill.
How do I know if my medical billing partner is performing this task?
Now that you know how important the ninth and tenth steps are, how do you determine if your outsourced medical biller is providing you with this feedback?
Here are some questions to ask:
- Is my medical biller looking for ways to increase productivity and profitability?
- Are they looking at performance standards of staff, both in the office and the outsourced staff?
- How often will my outsourced company provide me with helpful recommendations that will improve my processes?
- Will they help train my staff if any problems arise after feedback is given?
A good outsourced medical billing service will provide feedback in all of these areas. They will routinely review procedures to improve billing, payment, and records keeping. They will also have extra materials for training, staff on hand to answer any questions for office staff, and will perform a best practices comparison.
But they will also do more than that. Knowing the unique needs of each physician’s specialty is important. Providing unique, specialized feedback based on a physician’s specialty is crucial. Coding issues or insurance changes to specific specialties need to be incorporated into procedures and done in a way that increases productivity, not bogging it down. This is the eleventh step of an outsourced medical billing company: recognizing unique billing requirements of various specialties, and providing solutions for these requirements.
Clinic Service performs all of these tasks, offering free, ongoing consulting to continuously improve, performing a best practices comparison, and providing quarterly reports to physicians and staff. We have a team of full-time programmers who work constantly to upgrade and audit our system in order to address the ongoing insurance carriers’ changes and to provide solutions for the unique billing requirements of various specialties. We address unique billing challenges, specialty by specialty.
When choosing a new medical billing outsourced company, see if they offer steps 9, 10, and 11. If they don’t, keep looking.
Medical Billing Process Explained
The process of medical billing is simply stated as the process of communication between the provider and the insurance company. This is known as the billing cycle. The billing cycle can take in upwards of days to months to complete, and at times take several communications before resolution is reached.
The billing process begins with the medical care provider patient visit. The patient’s health record is then updated summarizing the diagnosis, treatment and any pertinent information. This information is then recorded electronically for future account updates.
From the patient record, an evaluation of care is determined and a five-digit procedure code is assigned from the procedural terminology database. The verbal diagnosis is also dictated in the record as an additional numerical code. These codes are used in claims during the billing process.
The next step in the medical billing process is to transmit these codes to the proper insurance company(s). In most cases, this is done electronically using an ANSI 837 file and is transmitted directly to the company. This claim is then processed.
Medical claims adjusters or examiners usually process claims, but when higher dollars are involved sometimes a medical director will evaluate the validity of the claim. Once the claim is approved the physician is reimbursed based on a pre-negotiated percentage. Any rejected claims are sent back in the form of Explanation of Benefits or Electronic Remittance Advice.
If the provider receives a rejection during the billing process, they must review the message, reconcile, make corrections and resubmit the claim. This exchange might be repeated several times before full reimbursement is made. Trying as the rejection process may be, the provider has to show patience during this time.
The number of rejections, denials etc. has been known to reach as high as 50%. This is mainly because of the complexity of the medical billing and coding system. Another reason for this is insurance companies denial of services not covered under the policy. Proof comes into play here and one can usually see success in overturning the original decision of denial.