Does your healthcare business struggle to keep up with your billing? One of the most challenging yet essential aspects of any healthcare business is billing. A healthcare provider submits a claim to the insurer, goes through a waiting period, follows up, and (if needed) appeals submitted claims that were denied. This can get overwhelming, especially for a constantly busy practice.
Finding an efficient way to manage administrative tasks is the best way to optimize procedures for faster and successful reimbursement. Every healthcare business needs to ensure they have success with their billing procedures.
How Does Medical Billing Work?
Medical billing begins with the patient and the provider. Once a patient completes their visit, diagnosis and procedure codes are assigned (known as ICD codes). These codes are used by insurers (payers) to determine coverage and medical necessity. This information is also included when submitting a medical claim to the payer. After the claim has been submitted, it will be processed by the payer. Some claims are automatically adjudicated, while others require examiners and adjusters for further processing.
Once the claim is approved, the healthcare provider is reimbursed according to contracted rates, and that completes the claims lifecycle. There are times, however, when claims are denied or rejected. When this happens, notice is given to the provider, and the provider can make necessary updates to the claim to resubmit it to the payer. Rejected claims are claims that did not go through claims processing because there was an error on the claim. Some errors include input errors or invalid data. This can be the case when the provider may have sent the claim to the wrong insurance provider or entered incorrect patient information.
- Use a Billing System with Practice Management
Now that we know how the process works let’s discuss how you can optimize your billing to be more efficient using practice management. One of the most common reasons why claims are denied is due to incorrect patient information. Typos, antiquated paper-based processing, and the lack of a workflow can be some of the reasons why patient information may be entered incorrectly.
Using a claims system with practice management, like NextGen EPM reporting, ensures accuracy by allowing the system to cross-check the data for errors. Using a practice management allows for data sharing across systems. You will no longer have to worry about inputting insurance provider information or patient information (electronic health records) every time you make billing statements.
Practice Management also provides training on best practices like automation of common administrative procedures such as claim generation and printing statements. Being able to automate claims and billing statements will help to ensure there are no errors and that your billing runs more efficiently.
- Utilize Flat Rate Monthly Billers
There are times when administrative tasks become overwhelming, and the quality of patient care suffers. When this occurs, it can lead to a loss of revenue. So instead, why not hire flat-rate monthly billers?
Flat rate monthly billers are experienced professionals in all things claims management. Payment posting, collecting copayments, prevention of coding errors (like under coding), and prevention of un-submitted claims are only to mention a few of the many tasks they can handle for your practice. This also prevents from taking away valuable resources your patients need while also alleviating stress from worrying about reimbursement procedures.
- Optimize Revenue Cycle
The third way to help your healthcare business to success is by automating and streamlining administrative procedures. Software like NextGen EPM reporting can automate and streamline various claim processes, which ultimately leads to better cash flow.
The software allows you to stay on top of your revenue cycle by tracking financial performance securely while also identifying trends. It also helps maximize productivity by effectively managing claim denials. Optimizing your revenue cycle is vital in ensuring your practice receives reimbursement from payers.
These are only to mention three ways to help your healthcare practice become successful. By following these tips, you will find that you will no longer be distracted with the administrative processes of your practice by allowing you to concentrate on your patients by providing them high-quality patient care.