Common Medical Billing Mistakes and Healthcare RCM Solutions

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Common Medical Billing Mistakes and Healthcare RCM Solutions to Improve Revenue and Collections

 

Providing medical care with the highest satisfaction of patients is the ultimate goal for a healthcare business; undoubtedly, reliable medical billing service plays a vital role in delivering quality care and avoiding common medical billing mistakes. Whether you have a physical therapy practice, internal medicine or family practice, or any other specialty, the most important thing is to have smooth RCM operations to ensure constant cash flow. Medical billing and denial management problems can slow you down, increasing pressure on your finances. Utilizing medical billing management companies decreases the possibility of encountering billing complications and effectively improves healthcare business offices and clinical workflow management efficiency. Medical Credentialing Service is the one fundamental service that medical billing companies offer to start things with new practices.

The fundamental problem in the healthcare business is collecting due balances from patients in a certain way it could improve the cash flow for healthcare entities. If you have an effective medical billing services company on board, you can automate the process of generating and tracking the due balances, sending reminders to the patient with a specific interval, and allowing the patients to pay the bills with ease of access. Due to the complex healthcare system, there are challenges, but a good RCM workflow can automate the payment collection process to achieve higher results.

The Seven Most Common Issues / Problems with In-House Medical Billing at Physician’s Offices and How to Fix Them:

The following is a list of seven common problems if you have an in-house medical billing department or planning to have one, along with the remedies to those problems!

1. An Absence of Necessary Information

It is common for medical billers at physicians’ offices to make the mistake of leaving important information off of a claim, such as patient’s demographics information, insurance information, and in case of auto accident claim accident/injury date and other worker compensation details. Even if the patient’s insurance has the benefits coverage and the claim can be processed towards reimbursement in the first attempt, not having enough information will result in more claim denials.

During the intake process, please check for missing or blank information. It is your best opportunity to spot omissions before they lead to a time-consuming procedure of denial and resubmission or contacting the patient for missing information.

2. Incorrect Identification Information Regarding the Patient

When entering patient information into your medical billing software or an EHR Software, you risk making claims reimbursement more difficult even if there are minor errors. It is common amongst clinicians that they face claims denials from insurance companies due to minor errors. If the denial management is not adequately set up, that can cause problems in getting the claims paid. Such mistakes as misspelling a patient’s name or changing their birth date can result in considerable losses in revenue and collection.

There are two approaches to taking care of this problem. The patient information should be taken by the intake department if that’s working separately from Medical Billing Staff working in-house. This allows them not to multi-task and focus on taking the most accurate information. The second step is to find a medical billing company that can help to perform a pre-submission claim audit to ensure that claims are going with maximum accuracy. Medical Billing Companies have software that can check the eligibility before generating the claims EDI files for submission. Their internal auditing process ensures that a validated clean claim is submitted to ensure timely reimbursement.

Imagine that before patients come in for their first evaluation visit, you ask them to enter their information, validate it with you, and later call them back, asking to verify the information as you have received a denial on the claim submitted to the insurance company. Healthcare providers must have a streamlined workflow to take the most accurate info from patients, which could result in faster reimbursement from insurance and patients.

3. Healthcare Claim Coding and Clinical Workflow Issues

Incorrect medical claims coding is one of the most common mistakes made by healthcare professionals and one of the most time-consuming mistakes. Claims may be incorrectly coded for a variety of reasons, including the following:

  • Utilization of expired Codes (CPT Codes and ICD-10 Diagnosis Codes)
  • Bundled Services Billed Without Modifier
  • Ignoring the Mutually Exclusive Edits (PTP Coding Edits)
  • Overcharging and Under Billing of Services
  • Incompatible CPT or ICD-10 Diagnosis Codes
  • Expired/Absolute CPT and ICD-10 DX Codes

The solution to these problems is to have a Top-Rated Medical Billing Company standing by your side that has all the automation and procedures in place to ensure that they don’t drop any ball while validating the claim and preparing it for submission the final claim. Most Medical Billing Companies ensure that the CPT/ICD-10 Diagnosis Codes are up to date and make consistency between the services provided. It helps healthcare professionals to maintain consistent healthcare coding standards. When you use Medical Billing Software or an EHR – Electronic Health Record, you can incorporate only the codes that are compatible with your specialty and the services you have selected to provide. This reduces human error and alerts the clinical staff when a selected service doesn’t qualify to be compatible with healthcare provider settings. The result is spending less time on Charting in EHR Software and focusing more on delivering quality care to your patients who needed the most.

4. Claims Submission More than Once

When dealing with different healthcare providers’ staff members, we have observed that they tend to resubmit the claim more than once, thinking that it will help to get the claim paid without focusing on why it has never been paid in the first place. There could be other mistakes leading to this one that might include patient billing as an option, as they might see that patient’s coverage has some issues. Unnecessary claim submission to insurance companies will result in multiple denials. Later, when in-house medical billing teams start to follow up, it becomes more challenging to determine which claim is the original and which should be rectified. If patient billing is also involved, which will reduce patient satisfaction, and healthcare offices end up getting bad reviews, this can ruin the whole healthcare business reputation.

The answer to such a problem lies in the automation of the medical billing process that is being handled by most healthcare RCM Solutions Providers to ensure that healthcare professionals get paid for the services provided. Medical Billing Companies have a process to detect duplicate submissions, and even rules can be enabled in EHR and RCM Software to ensure if anyone attempts to create a second charge for the same services and treatments, that must generate an alert. Medical Billing Staff training can also help to reduce such mistakes when managing an in-house medical billing team. Continuous training of the medical billing team is essential to keep up with the healthcare industry changes.

5. Insufficient Documentation

To process claims and make payments, all healthcare providers, physicians, and clinical staff members must maintain electronic copies of medical documentation. If not using an EHR, they must maintain the paper trail. Even though CMS has encouraged healthcare providers to use the EHR and issued significant incentives in the last decade to help in the adoption of EHR, some providers still use paper charting and have not evolved their process to the EHR-centric medical documentation record system or EMR – Electronic Medical Record systems. If you do not maintain the medical documentation, that can cause problems such as when insurance decides to hold the claim requesting medical documentation or later they may reject if they do not receive the medical docs in a certain period. Healthcare providers may face other challenges, such as CMS audits the practice to ensure they comply with all HIPAA, HITECH, and other regulatory requirements. To meet all the healthcare standards, healthcare providers must ensure that they maintain sufficient medical documentation to prove the necessity of the claim and comply with all healthcare regulatory laws and requirements.

Your medical billing services staff enables you to spend more time charting and maintaining the healthcare laws so you can do your job accurately. The expert medical billers at medical billing companies focus submit a clean claim and getting you paid as quickly as possible.

6. Change in Patient Insurance Coverage Due to Change in Employment

Many factors can affect a patient’s insurance coverage, including a change in employment. If you do not have an EHR System that could track the patient’s employment history, you would not be able to find a clue why claims are not getting paid suddenly, whereas this was not the case before. In addition, caps may be placed on the total number of visits or treatments paid by the employer-sponsored healthcare plan during their employment period. If these caps are exceeded, the patient will be liable for covering the additional costs.

If the healthcare claim is sent to insurance and denied, which requires the patient to update the COB – Coordination of Benefits, you must inform the patient about it. If claims are still being submitted and resubmitted incorrectly, it could result in costly delays and make it more challenging to recover from the patient health plan. Since you can’t identify the new insurance carrier, you won’t be able to get the claim paid. At each visit, it is essential to confirm that the patient is covered by their insurance plan. The healthcare provider intake department is responsible for confirming the patient’s insurance coverage when scheduling the appointment while ensuring their benefits have not expired.

Outsourcing medical billing to a professional healthcare RCM company with well-rounded denial management services can help you identify such claims denials so you can coordinate with your patients to see if they have any other insurance that can cover the cost or if they are willing to pay the cost out of their pocket.

7. The lack of Either a Referral or Prior Authorization

Patients enrolled in specific medical plans must receive a healthcare service from their PCP or Primary Care Physician. If patients need to visit any other specialty healthcare professional or a specialist for further diagnosis and treatment, they must have prior approval from the patient’s insurance; that’s called Prior Authorization. It’s common for healthcare providers to refer patients to other healthcare specialties they do not deal with so the patients can get the appropriate services.

But if the prior authorization has not been obtained by the insurance company, meaning approval has not been taken by the patient’s healthcare carrier before providing the services, that can also result in denials, and in a few cases, you even can’t request a retroactive authorization that allows you to request the prior authorization in the back date for the services has already been provided. To prevent this problem, you will need to confirm with the patient or with the insurance plan which type of services are covered in their plan and if they have out-of-network benefits in case of an HMO plan or they have a PPO plan that allows the patient to visit the wide range of healthcare providers. You will also need to ensure that your staff is aware of the constraints and regulations, and restrictions imposed by the healthcare insurance carrier so they can comply. If the patient does not have a referral or prior authorization, you might try to obtain one through collaborative efforts with the patient’s insurance carrier before providing the services and even before submitting the claim.

 

Paying attention to detail is required to have an effective medical billing workflow at healthcare offices. Taking care of these mistakes can help you guarantee that your healthcare claims are accurate to get reimbursement and that your patients are receiving the appropriate level of care. Automating these medical billing processes can also help achieve constant cash flow for your practice and fewer denials from insurance companies.

All healthcare professionals understand the importance of outsourced medical billing services. At some point, they have to hire an Outsourced Medical Billing Company that is more innovative and effective. Since there is still a significant amount of risk involved and many things can go wrong, healthcare professionals can’t afford to face such a significant loss.

 

Outsourced Medical Billing Services Company

Managing a healthcare practice without having the right team standing by your side is much more difficult. If you have decided to have an in-house medical billing team, constant training and improvement of the Healthcare RCM Workflow are essential. Your best, in this case, can be to hire a Professional Medical Billing Company and outsource all of your Revenue Cycle Management related tasks to the Outsourced Healthcare RCM Company. This will allow you to focus on your business workflow and make an improvement every next day.

 

You would like to Outsource Medical Billing Services? Contact Us Today to schedule an appointment with our Healthcare RCM Consultant and see how iCareBilling can help you to improve your revenues and collections.

 

What is iCareBilling

iCareBilling LLC is an American Healthcare IT Company that provides Medical Billing, Practice Management, and RCM Services to independent healthcare practices, small, medium, and large-sized medical groups, healthcare clinics, laboratories, telehealth practices, and hospitals throughout the United States.

Medical Billing Company Effect on Healthcare Business Growth

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How does a Medical Billing Company Impact Towards Healthcare Business Growth?

 

Medical billing and coding companies’ services are essential to robust growth in RCM – revenue cycle management in healthcare business settings. There are many factors a Medical Billing Company Effect on healthcare business growth, improved collections, and KPI indicators. This can be more effective and result-oriented when a top-rated medical billing services company is chosen. Generally, performing the tasks of insurance credentialing, medical billing and coding, is critical for ensuring compliance. Still, they are also essential for reducing the number of claims denied or rejected, which affects the revenue cycle management of healthcare business in the United States very badly. In today’s value-based healthcare environment, hospitals and other healthcare institutions are measured based on the quality of care provided. Even the slightest deviation in clinical documentation at the healthcare practice level can leave considerable gaps in the revenue stream and the delivery of quality care to the patients. This is because even the most minor deviation in documentation is based on the patient’s medical history that reflects on the claim. Clinical Documentation Improvement (CDI) will remain of paramount significance so long as your medical billing company continues to serve as the primary resource for small size medical practices, medical groups, and hospitals.

Claims Processing and Patient Billing Workflow

The efficiency of the people who manage the medical coding and billing processes significantly impacts the total cash flow that a medical practice generates. The provision of high-quality care to patients is the primary focus of all professionals working in the healthcare industry to ensure that the paperwork is completed in compliance with all regulatory requirements. On the other hand, increases in proportion to the number of patients generate more stress on the procedure being adopted to follow for the stability and continuity of healthy RCM workflow. However, as long as this paperwork perform accurately, you have no reason to be concerned about it. Effective medical billing and coding benefit patients, healthcare providers, and RCM solutions providers like medical billing companies. Having the right medical billing company standing by your side helps healthcare business owners and decision-makers responsible for delivering quality care. If you have a medical practice that has a system in place to identify the patient responsibilities accurately and automate the workflow to collect due balances from patients for finalized insurance claims, you can guarantee a consistent cash flow and revenue growth in healthcare practice, and that will increases the client satisfaction level significantly.

 

Medical Billing and RCM Key Performance Indicators for Healthcare RCM

Your ability to effectively identify and implement the KPIs (key performance indicators) is essential to determine your practice performance in achieving your goals. Medical billing companies generally have the KPIs being monitored by their employees to ensure lowering the number of claims that are denied and maintaining a healthy revenue cycle. When assessing key performance indicators (KPIs) in a value-based approach to healthcare, the efficiency of the medical billing companies matters because correct coding and documenting the process on the clinical side will only get benefits when expert medical billers are handling it. Two factors primarily determine these:

1.   Productivity in Coding:

The number of hours spent coding can be calculated by taking the entire records count and dividing that by hours spent by the clinical staff, such as Medical Directors or Directors of Nursing. What determines how efficient a process is is how little time it takes to do the most difficult tasks. Inpatient coding records should be completed at a rate of 24 per eight-hour paid workday as an example of an acceptable requirement for effective productivity in coding. Despite this, this metric will need to update due to additional coding tasks. The complexity of the management structure, case mixing, and other factors. The numbers can be improved if you have an EHR with a great SOAP Notes workflow designed based on your practice specialty and other needs.

2.   Accuracy in Coding: 

Since the healthcare organization is responsible for assigning coding levels, a policy document that evaluates how accurately the levels are coded is necessary. The official manuals and online coding tools can improve coding efficiency and serve as benchmarks. When using a Certified EHR, you will get the coding validation tool to ensure your procedure and diagnosis codes are compatible. Such EHR Systems also enable checking drug-to-drug and drug-to-disease allergies to ensure that no wrong medication is prescribed to the patient.

How Does Efficient Medical Billing and Coding Contribute to the Positive Aspects of Your Practice?

The following is a list of benefits that can be attributed to the preciseness and efficiency of the billing and coding process:

1. Having an Effective Medical Billing System reduces the number of Demands Placed On Physician And Their Support Staff :

The majority of those working in healthcare continuously undergo time sensitivity. Patient care consumes most of the staff’s available time during the day. If workers also have to make the claims ready for submission, check on rejections, follow up with insurance and perform payment posting tasks, their workload may become unmanageable. It is only a matter of time before a claim is filed, either with incorrect coding or with the correct one. Still, it takes more than time, such as hands-on experience, familiarization with insurance rules, and understanding the complex medical billing process, to get the claims finalized and paid by the insurance company. If industry experts do not handle the RCM process, this leads to denials, leading to a reduction in revenue. If you have an efficient medical billing company on board and working efficiently, there will be no delays in payment, and your employees will be free to concentrate more on the patients. The problems caused by unpaid claims and bad debts will no longer be an issue by having a top rated medical billing company working tirelessly for your success.

2. Avoidance of errors in medical billing that might have unfavorable repercussions in legal matters

When assigning a medical code to a particular treatment a provider supplies, a biller needs to pay careful attention to the particulars and look for the codes that most accurately describe the service delivered. When assigning a code to a medical operation, even the tiniest mistake might cause a delay in payment or even result in the denial of claims. Sometimes even such mistakes would result in sending clinical documents to the insurance companies to prove the necessity of the services delivered and filing a claim re-consideration, claim re-processing, or even filing appeals. Such billing and coding mistakes could potentially consider a criminal offense, and in some cases, insurance payers start investigating by having an audit of the healthcare practice. When deciding on a healthcare business opening, always choose a medical billing company that is efficient and accurate in case you don’t have an expert medical billing team to work for you in-house. You not only reduce the risk of legal ramifications but also eliminate the risk of any delays or denials instead of receiving compensation.

3. Assists in the Establishment of a Productive Procedure, Which Facilitates the Prompt Verification of Patients’ Eligibility:

An efficient workflow for the medical billing system will ensure that the patient’s eligibility information is checked well in advance. This will ensure that the claims are not denied, and that appropriate reimbursement will be received. This requires in-depth knowledge of insurance integration and usage of eligibility and coverage benefits verification. In the old days, the employees did the benefits verification manually. Still, nowadays, you can have medical billing software to check the patient’s eligibility and benefits verification automatically and instantly. Medical Billing Companies have the right tools in place that helps healthcare businesses to go easy on scheduling appointments, designing an easy intake process to collect patients’ data to ensure that biller has the most accurate information to bill the claims and get them paid in the first attempt.  To be efficient, you can be confident that you will top rated medical billing company on board, and you can utilize experienced medical billers to minimize the number of claim rejections whenever you submit them and get the required reimbursement more quickly.

 

4. Timely Payment of Claims and a Steady Flow of Cash to the Medical Practice:

When starting a medical practice, constant cash flow is vital to keep the business alive, and medical billing services for small practices can help you with that. The primary requirement for continuing medical practice is the provision of consistent financial resources to the organization. This is a possibility only if there are a few claims that deny. Claims that are filed for reimbursement must be accurate and comprehensive by having an efficient coding and billing procedure in place that ensures that these claims are being sent through a clearing house, get on file with insurance companies, get processed, finalized, and check is received in the healthcare provider’s bank account. This not only helps to ensure that claims pay in a timely and regular manner, but it also contributes to the overall health of the practice.

 

Need Help with Medical Billing Services?

If you are looking for a Healthcare RCM Solution that can help you improve your collections, and revenue, contact iCareBilling today by scheduling a call back and we will get back to you shortly.

 

Credentialing Services Process Improvement for Healthcare Providers

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Methods to Improve the Medical Billing and Credentialing Process for Healthcare Providers

Setting up the healthcare business has many challenges, and the most critical one is to find Credentialing Services for insurance enrollment and contracting for healthcare providers. If you are setting up a healthcare business, you need to start the insurance enrollment and credentialing process as soon as possible to avoid any issues in payments. Whether you are beginning your practice or adding a new doctor to your established healthcare group, it is essential to ensure all your doctor’s individual NPIs are linked with your group NPI (Type-2 NP) in the insurance records. It would be best if you recognized the significance of the credentialing process to avoid problems with claim denials which ultimately would result in decreased cash flow. When you are not ready to accept all insurances, that will result in fewer appointments scheduled, which will negatively impact claims billed and paid.

 

Insurance Credentialing Services to Start Process

Having an insurance credentialing services on board to act as credentialing coordinator helps to keep track of application submissions, send required documents, keeping records of deadlines and expirations for all insurance carriers. Regardless of whether the credentialing tasks handle in-house or outsourced to a third party, these tasks are always necessary to run to ensure you are getting paid continuously by the insurance plans. Outsourced insurance credentialing services have a process well designed to send timely reminders, calling the credentialing department of insurance to provide their required documents which ensures that credentialing status will expire for any insurance carrier. As a result, reimbursement requests for the claims submitted will not deny, and you will be paid faster.

 

Plan Credentialing Application Submission With Spare Time

Despite the fact that the credentialing process “should” take only 90 to 120 days, actual practices allow for up to 150 days or more if there would be any further complications. The process of insurance credentialing with different payers would require a different timeframe based on each insurance requirement, whether it is a government insurance plan, commercial, or an advantage plan. The time of taking providers in their network varies from one organization to the next. Assume that the whole process of obtaining credentials until getting the network contract will take 150 days, and consider yourself fortunate if it takes fewer days.

 

Participating in the CAQH Credentialing Solution Suite: 

The Coalition for Affordable Quality Healthcare (CAQH) standard credentialing program is gaining popularity among payers and will adopt by an increasing number of them. When physicians consistently update and attest their information with the CAQH Enrollment Hub, the credentialing and re-credentialing processes go more smoothly for everyone involved. This is one reason why interfacing with this program is so valuable.

 

New Provider Joining Healthcare Business to be Scheduled for Credentialing Paperwork

After making an offer of employment to a healthcare physician, as soon as they accept the offer, you need to immediately request their academic credentials, individual NPI, and other necessary information to start the credentialing process immediately. The best practice in the healthcare business to ensure you are ready before going live is to submit paperwork to your Credentialing Services Company at the beginning of a new physician’s employment. Starting the application earlier gives you more flexibility, and you will be able to designate the start date in the future date of a new physician’s employment instead of requesting the effective date in the past, which in some cases is denied by the insurance company if it’s too old from the date of Credentialing Application submission. Once you set the contract effective date, there will be fewer chances of getting your claims denials, and you will be able to work on Denial Management in case things go south effectively.

 

Credentialing Services Advantage for Future

Developing a credentialing procedure may be challenging when you are working in-house. If you have a Medical Billing Company standing by your side to help you with Credentialing Services, that can help you in the longer run. When you hire an Outsourced Credentialing Services Company to handle the process of granting credentials ready with all insurance companies, you buy some time to educate your newly joining healthcare physicians for the clinical workflow. Your Medical Billing Company working on your credentialing application can request the necessary forms to be signed and documentation to get things started to let you know to improve other business indicators. Running a multi-physician healthcare clinic or the medical group will require constant efforts to be made to ensure that practice is credentialed, linked, and all mandatory information is updated in the insurance system; you have higher chances of succeeding if the credentialing process is being handled by an Outsourced Medical Billing Company with the required expertise in Credentialing Services. Having a Credentialing Expert team standing by your side with a well-designed workflow would be of tremendous advantage to your healthcare practice.

 

Physician Credentialing Demographics and Keeping them Up to Date 

No matter if your Credentialing process was handled by an Outsourced RCM Solutions Provider or by an in-house Credentialing Coordinator, be sure that your credentialing demographics in the insurance system are p to date and accurate. This accuracy of healthcare provider’s information in the insurance system is not limited to the group information (healthcare practice); you also need to ensure that the accurate contact information for each physician in your practice is updated in the insurance system. When there is no direct communication between the parties involved, resolving issues involving initial credentialing or re-credentialing can take significantly more time than normal. The process of obtaining credentials also requires completing several forms to be signed and submitted, and maintaining open lines of communication is essential throughout.

 

Credentialing Services for Healthcare Providers

iCareBilling provides insurance enrollment and credentialing services to ensure you can buy more time to focus on improving your healthcare clinic workflow, and patient experiences. If you need help, contact iCareBilling Customer Service today and find out how we can help.

Medical Billing and Health Information Technology

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Medical Billing Companies offer great tools in the healthcare industry which evolve and set new trends and standards to improve patient care. The relationship between medical billing and health information technology is vital and the usage of the latest tools and techniques, and medical practices can make significant improvements in overall patient care standards and it influenced the healthcare sector positively. 

With the use of Care Coordination and Telemedicine, all covered entities which include Medical Billing Service, and other relevant entities can help to support the overall infrastructure to allow healthcare professionals to serve the nation by presenting the slogan “Better Healthcare for All”. In the last decade, all the covered entities in the healthcare industry have moved from EDI V4010 to EDI V5010 and the implementation of ICD-10 in the last decade has made significant development to accommodate new technologies and procedures. 

This new technology is helping healthcare professionals to exchange information to improve patients’ health conditions with better clinical analysis and reporting. Telemedicine demonstrates different applications which can be used two ways via email, video call, wireless tools, and any other forms of communication technology and this is greatly helping to reduce the barriers between patient and doctor. Medical Billing Companies like iCareBilling offers their clients the best tools to accommodate their needs along with Medical Billing Services Here are the few benefits we all will be getting by using telemedicine tools in the healthcare industry.

  1. Extending care for remote areas
  2. Helping larger institutions to deliver better clinical care to their patients
  3. Better reimbursement and not a huge difference between the fee schedule of services rendered on-site vs remote patient monitoring 
  4. Close coordination with HIT for effective use of technology for better healthcare
  5. Using electronic tools which will help physicians to adopt EHR, and Web, Cloud-Based Practice Management Systems
  6. Ease of Access and reduce traveling cost
  7. Better Management of Healthcare by using Technology Adoption

Medical Billing for Healthcare Services Providers

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Finding the perfect match in the list of Medical Billing Companies is hard, but with the right knowledge, you can identify the Best Medical Billing Company for healthcare services providers, hospitals, and group medical practices. While growing, you come to a point, where you need Outsourced Medical Billing Services to improve productivity and get some time off to focus on the core healthcare business.

However, every physician practice will not have the same needs. It’s very common to find similarities in other healthcare groups, but each practice has its own specific needs. When looking for medical billing companies, you need to find the right billing partner to meet your practice needs. Here are some key points to consider when shortlisting and making a final selection of an ideal Medical Billing Company that can meet your unique needs.

Flexible RCM / Medical Billing Service

If you are already using EHR / Practice Management Software, you have to look for such Medical Billing Companies that offer flexible medical billing services so you don’t need to switch your lovely EHR.

Medical Billing Software Dependency

If you are not using any EHR / Practice Management System and would like to move on to one with a new billing company then you have to look for a specialty-focused EHR along with a specialty-focused medical billing company. Every Medical Billing Software and EHR System is not designed for all types of specialties and you need an EHR & Billing System which has additional functionalities just more than just an appointment scheduling system.

Suitable Solution for ICD and CPT Coding on Claims

The medical billing service should have the solution to take your manual billing and coding details and put them together in a claim with proper identification of diagnosis information to the relevant procedures performed along with relevant modifiers to avoid claim necessity denials. This section has a dependency on the efficiency of the medical billing team and the medical billing software design which allows making this happens as expected. If a medical billing company lacks in this area, the majority of your claims will be either rejected by the clearinghouse or will be denied by the insurance company due to “inconsistent diagnosis code”, “invalid/missing modifier” or with denial reason “services provided doesn’t prove the necessity”.

Electronic Healthcare Claim EDI Processing

Once the encounters are uploaded for the billing team, these should be processed and sent to the insurance company electronically with EDI (Electronic Data Interchange) or via paper. An Experienced Medical Billing Service checks each insurance requirement and prepares the claim in accordance with a checklist to ensure the first time passing through all the checks to get the claim on file. When dealing with claims electronic submission, the selection of an EDI vendor is also important to make sure that the Medical Billing Company is using the efficient EDI Vendor to ensure claim submission processing.

Healthcare Claims Aging Follow-Ups

The task of medical billing and providing end-to-end revenue cycle management services is more than a data entry of patients’ demographics, claims, and submissions. The expert medical billing team has to look into the claim’s status after certain days of claim submission to ensure that claims sent to the insurance are on file and get the updated status. In case the sent claims are rejected or denied by the insurance payer, then it comes to the billing team’s efficiency to utilize their medical billing skills to get them paid by fixing the issues/errors on them.

Medical Billing Companies having a standard process of claims follow-up to get the claims paid is always being recommended by physicians as the number 1 choice for medical billing solutions.

Medical Billing Periodic Reporting

A perfect medical billing solution provider keeps its clients updated on payments through periodic reports. The more efficient a billing team is, the better they would keep the practice notified about the daily, weekly, and monthly status of the payments received from the payer. The physician medical billing services provider should also update the revenue earned in a certain period of time.

Medical Billing with Efficient Customer Service

A Good Medical Billing Company always invests in providing efficient customer service to their clients to answer their queries in the shortest possible time. If you are the person working on emails and do not prefer to go on calls due to a shortage of time, check the most responsive medical billing company process of handling client communication and always choose the one with the best response rate recommended by their clients.

If you need help in resolving your healthcare practice medical billing issues, please schedule a call back with our Medical Billing Expert to discuss the details. Our initial consultation is free.

Healthcare RCM Services to Improve in Healthcare Practices Cashflow

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If you are facing problems around cash flow in healthcare practices, you should reconsider checking the workflow at your medical practice to improve the medical billing and collections process. It is hard to keep up with healthcare changes and updates, but it can be done with the right medical billing processes in place which helps you to be more organized. Even though the medical billing process is not the one reason which needs to be improved but it is the most important one when considering improving Medical Practice Cashflow and Collections. Healthcare Denial Management has always been an important factor to consider while checking the Medical Billing and Collection Process.

Manage Cash Flow in Healthcare Industry

Medical Practice Collections depend on different factors and directly and indirectly impact the revenue of your practice. Outsourced Medical Billing Company can help you to streamline the workflow at your healthcare practice. It can play a vital role in maximizing revenue and collections. A Medical Billing Process that is aligned with your medical practice needs is vital to improving the key performance indicators and it can give a boost to your medical practice’s financial stability. Here are a few tips which can help you to improve your Medical Billing Process which will result in Improved Practice Collections.

Medical Practice Staff Training

Investing in human resource development has always been regarded as the most beneficial long-term investment. In healthcare practice, staff members must be trained to round all corners to ensure a consistent cash flow. Develop the standard operating procedures to provide guidelines on how to react and certain types of situations.

Research and Analysis on Denial Management in Healthcare

Help your medical billing team to learn the process of denial management in healthcare to ensure all the denied and rejected claims are being taken care of shortly. Any delay in acting on the denied claim would further reduce the chances to collect possible reimbursement.

Efficient Patient Billing Process

Due to not having an efficient medical billing company standing by your side along with not having an efficient collections process, you might end up having unpaid claims for patient balances. Help your front desk and billing team to bill the patient immediately after the services are provided. If they are self-pay patients and requested an itemized statement to release the payment. Delay inpatient billing would increase your healthcare practice’s account receivable volume.

Billing Efforts and Effective Practice Management System

It’s equally important to have an effective practice management system integrated with EHR System to achieve the required results. If the practice management system is not efficient, consider checking out a different solution to meet your needs. It’s vital to have a system that could support your healthcare practice needs to bill the healthcare claims to insurance, find out remaining/unpaid balances, run claim tracking and provide medical billing analytics to help you make strategic decisions in a timely fashion.

Help Patients by Giving them the Flexibility of Patient Payment Plans

We all know that not all patients feel comfortable putting a burden on their Credit Card and cannot pay the full amount as cash-pay clients. You need to consider checking the patient payment plans and offering flexibility to your patients. This would increase the client’s trust in your healthcare practice, and you will get constant payments without sending reminder emails or sending paper statements which is of course another cost.

Healthcare Practice Bad Debts and Old Unpaid Claims

Always check the options of old unpaid claims which most healthcare physicians consider just writing them off. Follow up with payers to see if you get some payments or re-negotiate the price and make final adjustments by accepting less payment but at least getting something out of it. In the case of Auto-Accident Healthcare Claims, most claim adjusters offer the claim settlement which can be an easy solution to get the payment. In the case of patient payment, you can offer the same deal instead of involving a collection agency and paying approximately two-thirds of the bill amount to them. Providing discounts to patients on pending bills would increase your chances to get paid faster. On the other side, this would improve their trust and confidence in your healthcare practice.

Get Help in Maximizing Cash Flow for your Healthcare Practice

If you are facing cash flow issues in healthcare practices and need help streamlining your medical billing workflow, please contact us today and talk to an expert Medical Biller at Top Ranked Medical Billing Company.

Outsourced Medical Billing Companies Impact on Healthcare Providers Financial Stability

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Healthcare providers financial stability is essential for private healthcare practices to grow and keep providing valuable healthcare services to our nation. Today we will talk about how Outsourced Medical Billing Companies impact positively on healthcare businesses’ financial stability and some key metrics in financial reports so we could understand finance better and manage our healthcare businesses effectively. When we talk about the financial statements for medical practices or medical practices’ financial policy, we must think about the basic question “what is the purpose of medical practice’s financial policy?”. Medical practice owners need to regularly check the financial health of their healthcare business such as medical practice financial ratios or financial statements.

Analyzing the financial health of your medical practice can be easy when you have the right indicators to look at. The majority of the physicians or practice owners are not aware of the financial indicators they need to check to get better insight into the financial stability or financial health side of the business. Thinking this way can keep the decision-makers informed about the medical practice’s financial ratios. It also helps to update the medical practice’s financial policy to make strategic decisions in a timely fashion. The financial policy of a medical practice plays an important role in keeping your medical billing and collection process smoother and keeping your practice cash flow at an optimum level to achieve higher performance. There are many creative ways to maximize cash flow in healthcare but most importantly you need to look at the financial statements for medical practices to make decisions about the upcoming changes in your medical practice financial policy. In some scenarios, you might need to improve healthcare practices workflow to gain access to the financial stability of your healthcare facility. If you are doing in-house billing and facing cash flow problems, you might need help from the Best Medical Billing Company to realign your strategies.

Financial Statements for Medical Practices

First and most importantly, you need Medical Billing Services which could provide you could provide you the monthly financial statements for your Medical Practice to keep you informed about insurance payments, patient payments, and pending accounts receivable reports. If you do not have the right Medical Billing Solution which could generate valuable Medical Billing Analytics for you, you won’t be able to drive long enough without looking at the dashboard of your business.

Medical Practice Financial Policy

You must design your medical practice financial policy on how to collect payments from insurance and patients. Having a Best Medical Billing Company by your side will help you to fix the problem of collecting insurance payments for medical claims but that’s not enough. You should think about the most innovative and creative Ways to Improve Patient Payment Collections. At the beginning of every year, your patient balance would increase due to deductible processing and you must think about the different ways how to collect deductibles from patients this should be a part of your Medical Practice Financial Policy and this would help you to look at the medical practice financial ratios.

What is the Purpose of a Medical Practice’s Financial Policy?

The purpose of a medical practice’s financial policy is to create, maintain and inform your patients about the SOPs (standard operating procedures) to collect pending payments from patients after the claim’s processing from insurance companies or collect directly from patients in case of self-pay visits. If we talk about the broader aim of Medical Practice’s Financial Policy, it should include the Medical Billing and Collections Process as well. When you start thinking about collecting more from insurance and patients for your Medical Practice, you should have a dedicated medical billing team to work on Denial Management for your Healthcare / Medical Practice to collect every dollar from the insurance company and then send a statement to the patient for collection of patient responsibility.

Medical Practice Financial Ratios

Analysis of medical practice financial ratios helps you to determine your medical practice’s financial health. You can compare the results of these ratios with health industry benchmarks to make improvements. Medical practice financial ratios can be calculated in two different ways. Here we will talk about some financial terms to help you better understand the concept of Medical Practice Financial Ratios.

Medical Practice Financial Health with Current Ratios Method

You can assess the financial health of your medical practice with the current ratio. In this method, you have to make the total sum of liabilities and assets of your medical practice and then divide the current assets by your medical practice’s current liabilities for the year with its total cash value. The higher value of your medical practice current ratio will show the healthy indicator which is generally between 1-3. If your medical practice’s current ratio falls below 1 then it’s an alarming sign and you should really have serious doubts about your medical practice’s stability.

Medical Practice Financial Health with Acid-Test Ratios or Quick Ratio Method

If you would like to check your medical practice’s financial health stability analysis with a Quick Ratio Known as Acid-Test Ratio, you should divide cash in hand (available cash), short-term investments portfolios, and account receivables sum total by the current liabilities of your medical practice. If the result gives you a number of more than 1, then your medical practice has the ability to bear the current liabilities’ financial burden and if the number is less than 1 then you should look closely at the numbers and reconsider making some improvements by the next fiscal year to have better financial stability. Please note that when we talk about account receivables, if you don’t have accurate medical billing analytics, you can’t bring inaccurate numbers. To have better access to accurate medical billing analytics, you should rely on a Top Rated Medical Billing Company that can deliver on-demand reports for your Account Receivables (Unpaid/Aged Pending Medical Claims).

These are just the numbers to run but sometimes you can even feel the financial stability by just looking at your current cash flow and income/expenses sheet. To avoid financial loss and improve the Practice’s Stability, you need a Good Medical Billing Service so you could focus on business growth with peace of mind. If you need help in Medical Billing, Contact Us today and talk to a Medical Billing Expert to check the Best Medical Billing Solution for your Medical Practice.

Medical Billing Services Outsourcing to Improve Medical Practice Cashflow

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Medical Billing Services Outsourcing and Impact on Medical Practices Revenue and Cashflow

Identifying the right diagnoses, writing prescriptions, or operating on patients is only a small part of what it takes to run a successful medical practice. There is also the aspect of managing the business side of things when it comes to operating a medical office, or really any business. You may guarantee that you will compensate for all of the services you provide by putting in place medical billing service procedures and then ensuring adherence to those procedures.

 

Medical billing services:

Your medical practices RCM activities start with scheduling the patient appointment and that’s the point from where you need medical billing services. You have an agreement with the patient and continue until the bill will pay in full. It could appear to be a lot at first, but if you break it down into smaller steps. You’ll find that it’s not quite as intimidating. In order to maintain your healthcare practice operational, one of the most important things you can do is ensure that the team with the right experience is on board to provide appropriate medical billing services.

The Processes Involved in Medical Billing Services

Here are a few critical processes that shall include in your medical billing service procedures. Whether you are just getting started with medical billing services or if you are wanting to improve your present system:

  • Make a record of the patient in the EHR/EMR system.
  • Check on the insurance eligibility and benefits verification.
  • Document the details of each visit.
  • Sharing your medical procedure details such as charting the billing team
  • Add appropriate diagnosis and procedure codes
  • Prepare medical claim
  • Examine the claim.
  • Payment and follow-up
  • Prepare the patient statement

Develop a patient registration form:

Develop a patient registration form that compiles all of the essential information that you will require. Such as patient demographics, the patient’s referral provider, insurance identification, and any other necessary details. This data will be utilized during the subsequent visits, and the patient’s medical record will be kept current as circumstances warrant.

Verify the patient’s insurance information and coverage

Verify the patient’s insurance information and coverage before the appointment. And ask to see their insurance card to ensure that you have all of the necessary details. This step is necessary to ensure that there will be no unexpected charges further down the line. During subsequent visits, you will still need to verify that they have the same insurance data that will contain in your medical record and ensures the coverage eligibility with the insurance company.

Coders in the medical industry

Coders in the medical industry will make use of the medical clinical documentation in order to assign the codes. That is most appropriate for the services that will render. It is important to obtain a medical history during the first visit. And then monitor it for any changes during the following visits. The medical transcription will incorporate each and every one of these pieces of information.

Completion of the review of the medical notes, or transcription

Following the completion of the review of the medical notes, or transcription if the provider transcribes and doesn’t use the charting system. It will then prepare for delivery to your medical billers. Some healthcare providers handle the billing and coding on their own. While others contract out the work to a third party like medical billing services. Because of this, you need to make sure that the record of the visit is thorough and describes everything in detail. When this step of the process will complete, the charge entry process will be started to prepare the healthcare claim with the right diagnosis code, procedure code, date of service, and other necessary information to get the claim ready to transmit.

The medical claim will transmit:

Following this, the medical claim will transmit to the insurance companies, worker compensation, auto injury, or employer-funded insurance plans for the purposes of review and processing. Before sending the information to the insurance payers for reimbursement, the healthcare claim has to go through an internal audit generally known as “scrubbing,” during which any problems or errors that may have been applied will check for. Every medical billing company has its own rule-based engine to ensure the accuracy and completeness of the medical claim to avoid rejections. The claim scrubbing process is utilized to check the accuracy of each field in the claim HCFA-1500 Form or UB-04 form which also verifies each individual insurance requirement based on service type and the plan of care.

Review the claim and look for any discrepancies:

If the claim is rejected or denied, it needs to be checked if there are any errors or if the patient underwent any operations that were not covered by their particular insurance policy, if the policy was not active on the date of service, or if there is any incorrection information submitted on the claim. The majority of the time, insurance companies will provide an explanation for a claim that was rejected or denied so that any issues can be resolved.

 

The remaining balance (if any) will engage accounts receivable workflow to submit it to the patient, or financial granter once the claim will be processed or finalized by the insurance company and the final decision about reimbursement has been made. They will first generate a patient statement that explains the remaining balance along with reason or remarks, and then they will submit the invoice to the responsible party whether it is secondary insurance, the patient, or the financial granter of the patient.

Track down any past-due bills:

When the medical claim or bill is paid, this money-making cycle generally called RCM Process is over. Even so, you may require to track down any past-due bills, which is typically the most difficult part of the process for many medical practices that involve the whole denial management strategy. It is essential to take the help of medical billing companies that have experienced teams of medical billers in order to guarantee that you will be paid for the services that you provide. Sometimes heavy medical bills which are sent to patients as patient responsibility need a little more care from the billing team and healthcare provider end to ensure patients get the easy installment options with specific percentage write-offs as a professional courtesy in case they wanted to pay off the whole amount at once. This helps to retain the healthcare office’s clients (Patients) and on a practice level, keeps a steady cash flow.

Well-defined medical billing systems

It is important for your medical office to have a well-defined medical billing system run by an experienced medical billing company in place to assist guarantee that it runs smoothly. That will help to get reimbursed for all of the services that you perform in the healthcare facility. It is possible that getting everything organized will take a little bit of time, but in the long run, it will be well worth the effort.

 

It is simple to lose track of payments or to find oneself dealing with patients whose bills have not been fully paid. You can spare yourself a lot of hassles in the future by having an experienced and well-recognized medical billing company like “iCareBilling LLC” to properly set up your medical billing and collection processes and workflow in place. If you are facing difficulty in getting paid by the insurance company in a timely fashion, you can reach out iCareBilling to schedule a free medical billing consultation to learn more about how the current workflow can be improved. It might be challenging to maintain a steady cash flow by yourself because you have been trained for years to treat patients, not to manage the RCM side of your business. Let the experts handle this task so you can focus on patient care.

Outsourced Medical Billing Company Advantages

Outsourced Medical Billing Company Advantages for Revenue Growth

 

There are many reasons why medical billing company outsourcing services are becoming increasingly popular. Medical billing, practice management, or healthcare RCM services outsourcing is no longer a traditional business but more of an innovative method to operate and grow in the healthcare industry. The use of outsourcing services has recently become extremely common. It simplifies procedures, improves systems, uses cutting-edge technology, and helps the economies of scale, and complexity in the healthcare system that ultimately create a need for an experienced workforce. These Healthcare IT businesses are mostly loaded with specialized knowledge and expertise, which often provides greater cost savings and outcomes to the healthcare industry.

 

Medical billing company Outsourcing Services:

In today’s world, the healthcare industry is both complex and constantly changing at the same time. Effective management of processes and workflows at medical billing companies is proving to be a strategic advantage point for healthcare practitioners not to jump into an industry they have not been trained so far. It should come as no surprise that medical professionals, healthcare facilities, hospitals, and practice managers generally start doing medical billing on their own until they realize they need medical billing experts to handle the revenue cycle management side of their healthcare businesses or entities. The Healthcare industry overall embraced medical billing and coding outsourcing as their ace in the efforts of improving their financial standing and keeping the medical practice at stability and having steady revenues and profits. Healthcare and health plan processing companies often need a hand outside of their business to look at the business dynamics from a different perspective and for that, they definitely need a highly professional and expert medical billing specialist. On top of this becoming a HIPAA-compliant entity while operating business as usual has become the ideal choice for hundreds of medical offices not because they want to but because they should and there is no question about it. There is not sufficient need to discuss how regulatory authorities try to enforce this as a part of the healthcare industry no matter if the healthcare business entity is small, medium size or big, or the medical office is a family practice, clinic, hospital, medical groups or even if that is medical billing companies or any healthcare corporations because all these are covered entities according to HIPAA (Health Insurance Portability and Accountability Act of 1996) and OIG (the Office of Inspector General) guidelines and all must comply. There is no doubt that outsourcing medical billing services companies have just established a foothold in the market as a cost-saving solution. In point of fact, it is the most considerable factor that is driving the trend among customers, but it also matters a lot to those who are increasingly perceiving it as a tool that delivers wide-ranging benefits to their businesses’ innovations and improving result-oriented care for their patients.

First, let’s have a look at some of the benefits:

1. Mainly Concentrates on the Treatment of Patients

Combining the responsibilities of a medical practitioner, along with the office administrative manager is never without its share of obstacles. Shifting your view from healthcare treatment to billing questions during the process of patient care is not an ideal situation. Healthcare providers can boost profits by adopting the most customizable workflow that fits the healthcare organization’s needs and not worrying about medical billing and denial management issues. These high-value activities not only bring in additional cash for the medical facilities but also contribute to the development and improvement of patient care standards and methods. The maintenance of a prosperous medical practice that is supported by a dedicated patient population is critical. It needs a lot of time and effort to focus on building a great healthcare business that can support the community in a greater way. And this is only if that healthcare business is backed by a top ranked medical billing company. As a result, medical professionals are freed from the need to negotiate with many payers and meet various regulatory requirements. This allows them to devote their whole attention to the areas in which they excel, “the practice of medicine and the care of patients” which is and should be the ultimate goal of healthcare providers.

2. Expert Medical Billers Help Reduces Inaccuracies in Billing

Medical billers who have years of experience and receive thorough training have a comprehensive understanding. The intricate processes are involved in submitting claims, payment posting, follow-up, and in overall RCM activities for any healthcare practice. Medical billing companies make it a point to ensure that their employees successfully complete rigorous process training, and they have needed quality and domain-driven knowledge testing. These medical billers are responsible for ensuring that their submissions are accurate and made within the appropriate time frame to ensure reimbursement from insurance companies in a timely fashion and not getting the medical billing denial of “exceeding timely filing”. Medical billing solutions providers not only cut down on the number of claims that are denied, but they also check and correct payers, claim coding aspects, and any other errors that might be in the claim before sending it off to the payer.

3. Medical Billing Companies Helps Save Money

Among healthcare providers outsourcing has traditionally been the desire to realize cost savings. The cost of salaries, employee training, and benefits can be reduced by independent healthcare practices, medical group practices, hospitals, laboratory services, and other medical specialties. Apart from cost-effectiveness, workflow improvement is the major benefit any healthcare professional can get by outsourcing their medical billing tasks to top-rated medical billing companies. It is also possible for hospitals to avoid incurring expenditures associated with the acquisition of new or upgraded hardware or software such as EHR (electronic health record), EMR (electronic medical record), practice management, or medical billing software if the whole medical billing operations are not set up as in-house managed by the healthcare facility. Apart from these expenses, office supplies, furnishings, office space, and many other expenses can add up to a huge cost to the healthcare providers which is not quite the right decision when you can have everything managed outside of the office by someone who knows what they are doing. Many patients go with those medical specialists where they could get great onboarding patient experience rather than any medical professional who is trying to get everything done on their own and messing around between the tasks of patient care and medical billing or RCM Services. The same is happening with a medical office with multiple staff trying to manage the RCM and Clinical workflow at the same time. As a healthcare professional you can add more valuable services to your practice with a fraction of the cost and stay ahead of your competitors. The amazing part is that you can pay these outsourcing medical billing companies only a specific percentage of reimbursement received from the insurance companies, and no need to worry about matching 401K benefits or paying other benefits to your employees. Medical billing companies offer the highest value standards to their clients with proven medical billing workflows to improve their revenues and collections. Cost-effective medical billing companies are always there to help you make the most out of your time and money and your customers (patients) always feel the difference when their medical bills get paid without any trouble. In the long run, choosing the right medical billing company for your healthcare business would pay off by having more patients looking for your services, which means more revenue = more profit.

4. Use of Healthcare RCM Services to Increase the Cash Flow

Maintaining a regular and constant cash flow at healthcare practices is not easy unless you do not have a medical billing workflow in place. No matter you are a small medical practice or a larger healthcare group or hospital, you are able to maintain a regular cash flow and faster reimbursement when medical billing companies outsourcing services are utilized to help you to cut every corner for you. This is true regardless of the size of your healthcare business, type of specialty, the workflow of your patient care, or anything else. Healthcare offices often have staffing situations where they are not able to find the right person in the local community who could come and visit the office which doesn’t happen all the time. Many healthcare facilities end up hiring someone remote far away from their practice location, then why not outsource to a medical billing company that can deliver the best results? By outsourcing the time-consuming task of medical billing to a professional practice management company you buy the time for yourself that can be utilized to make your healthcare business more innovative and appealing to your customers. Bigger healthcare organizations, larger medical groups, and hospitals choose to outsource their practice management tasks to the outsourcing practice management companies in a very early stage of their business, and they make decisions in the favor of greater economies of scale in their operations to let the medical billing services providers help them out in the area they can’t help themself.

5. Well-Designed Healthcare RCM Workflow Improves Patient Satisfaction

The primary focus of the outsourced vendors in the revenue cycle management industry in healthcare is increasing and the major reason could be to focus on patient satisfaction. Customers who are actually patients always try to find healthcare solutions that are affordable, and they could have a great patient experience. Adopting a well-designed healthcare RCM workflow helps the healthcare practices to position themselves where patients could see that the services are affordable and they can solely rely on the treatment offered by the healthcare provider without worrying about anything else. The use of offshore medical billing services guarantees the healthcare professionals that their patients each CPT code for the services rendered will receive the appropriate compensation in a timely manner from the insurance companies, worker compensation plans, and third-party payers. If the medical billing workflow is well designed by the medical billing company and customized for the healthcare providers’ needs, any errors will be recognized promptly, and denials will be followed up on immediately to get you paid for the services rendered to your patients. On the other side, healthcare practitioners are able to provide their patients with outstanding customer service which is the key to success and this key factor is not going to go away anytime in the future. So healthcare businesses can have more potential to be more compassionate and humane which could win the hearts of your patients and everyone could fall in love with your services.

6. Medical Billing Companies Ensure Compliance Standards

Since the beginning of this century, all healthcare business were ought to comply with HIPAA, OIG, and other healthcare standards and they need to ensure that all of the business activities are in compliance without any exceptions to it. Medical billing companies always make sure that their internal processes, communications, work ethics, and standard operating procedures are in compliance with HIPAA while providing medical billing, practice management, or healthcare RCM services to the healthcare industry. Any healthcare outsourcing company that is providing back office solutions to clinics and hospitals is subject to the same rules when providing their services to healthcare businesses all over the United States. An organization that has reached a mature stage will always make sure that compliance is thoroughly ingrained in all of its operations, and internal/external audits are conducted on the regular basis to ensure the implementation of all the required rules and procedures.

Medical Billing Company Impact on Practice Revenue Growth

How does a medical billing company impact revenue growth and help to stop revenue leakage? 

Hospitals, physicians, and healthcare systems all rely on a complex revenue cycle to manage and collect compensation for the services they deliver to their patients. Patient registration, benefits, and insurance verification. Medical Billing Company follows the process of claims filing, payment posting, denials handling, and report generation that positively impacts healthcare practice’s revenue growth. Unnoticed revenue leakage at these stages might cost thousands of dollars due to inefficiency and negligence.

 

Strategies to Stop Money from Leaking Out of Your medical billing company:

With the resources provided by Right Medical Billing company, you can stop losing money even while you labor tirelessly to keep the lights on. You may boost profits and cut expenses by following these suggestions.

The primary goal shall be to avoid rejections and have sufficient expertise to perform all the clinic tasks. 

Clinics need to know that ignoring a doctor’s other doctor’s referrals to accept patients from certain insurance plans can have a big cost. But you can only accept patients from all plans if your practice is credentialed with insurance plans. Being in-network with insurance plans helps you to take in more patients, and medical billing companies can help you to get credentials so fast. If the doctor has credentialing issues, it may lead to more claims being denied. The complexity of payer-specific credentialing standard are associated high rate of credentialing application denials, and these can be reduced by using a professional credentialing service from experts. Identifying and getting the healthcare professional re-credentialed with the help of medical billing services professional team will decrease the number of denials and improve revenue and collection. Your practice might consider having the credentialing process handled by an outside business.

 

Procedures That Were Not Billed

Physicians need to be familiar with valid specialty CPTs / procedures codes to reduce the number of unrecorded small procedures, and such errors can be reduced by utilizing a billing company. The ability of physicians to check and verify the valid CPT codes and diagnosis codes reduces the number of bad claims billed to the insurance companies that come back with good check amounts which increases the revenue. In most cases, revenue leakage is caused by unbilled treatments that can identify by a medical billing expert following an in-depth analysis of clinical documents and a treatment plan signed by the rendering provider.

 

Claims That Are Not Yet Bill

The loss of revenue due to unbilled claims is greater than the loss due to any other cause. By correlating reports of patient appointments, procedures performed and claims made medical billing company expert staff can easily identify the unbilled claims and submit them within the insurance’s timely filing limit to get the claims paid without any late filing denials.

 

Managing Patient Balances

Creating an effective procedure for managing patient balances is as important as treating the patient and checking other areas of practice. The billing company always designs an effective follow-up strategy for patient balances followed by patient recall/texts, electronic statement generation, and paper statement generation along with flexible payment options and flexible payment plans. These standard procedures from Healthcare RCM Companies will ensure that the patient receives the due balance on time. They are constantly reminded to pay the patient’s responsibilities to the physician’s offices as soon as possible.

 

Underpayments

Knowing the exact cost of the medical billing service always seems cheaper when you know the cost you could pay for any medical procedure underbilled and paid less than average. As a healthcare professional you provide the best treatment to the patient but are still unable to collect money and generate income because the top-rated medical billing company did not handle the Billing process. By preparing ahead and making necessary adjustments to your fee schedule as soon as possible, you can prevent having deductions taken from your pay at various insurance companies. Ask medical billing experts for support in putting up your enhanced fee schedule.

 

Inefficient Claim Denial Management

The management of denied claims is necessary along with the other healthcare RCM activities. Management of denied claims needs the hand of medical billing experts. Outsourcing to a medical billing company that has expert staff will help you resubmit the wrongly denied claims with proper corrections to avoid the previously received denials. These experts figure out the reasons why denials occur and then take corrective and preventive measures to ensure these denials don’t happen again and claims get paid on the first attempt.

 

In-House Billing Workflow Issues

The workflow issues between staff cause inefficiencies in the billing departments that may be caused by inadequate training or not designing a proper workflow. Having a medical billing company doing the medical billing helps you to focus on your clinical staff training to treat patients in an effective manner that will improve the overall patient experience. Put your faith in your passion to deliver the best healthcare services to your patients who will market your healthcare business resulting in more patients and revenue.

 

Make Full Use of Data and Analytical Tools

The majority of medical billing companies billing software includes several reporting functionalities. You may quickly generate reports on the operational and financial performance of your practice by making use of these tools. Make the appropriate judgments while keeping in mind the most important things you’ve discovered through root cause analysis.

 

Prioritization of the Patient

Your organization in the healthcare field has the primary obligation to ensure the health and happiness of its patients. Outsourcing complex medical billing tasks gives you more time to focus on your responsibilities as a healthcare professional and treat patients better, provide more robust and flexible solutions and train your clinical staff members. You can dedicate your staff to maintaining healthy and constant communication with your patient to reduce barriers and improve patient connections.

Medical Billing Practices to Maintain a Healthy Cash flow:

The majority of doctors start their private practice because they want to help people and built trusting relationships with their patients. However, it is challenging to remain profitable in the current market due to the Affordable Care Act and ICD-10 changes. The impact of all these variables can be reduced if you Outsource the RCM activities to the medical billing company this way you can save a lot of money and buy more time for you and your business growth.

It’s common to wish you could leave the stresses of running a private practice and join a hospital or large healthcare organization. The medical clinic you run is a business just like any other. The flow of money is important to main a healthy cash flow. The challenge, of course, is to increase the former while decreasing the latter. Your medical practice’s bottom line is directly affected by certain factors.

 

Outsourced Medical Billing Companies 

The best idea is to find a top-rated Medical Billing Company that can help you with Practice Management and RCM tasks so you can take control of your practice. When you get more time, you can perform the tasks such as internal audit, financial control, patient experience improvement, communication improvement with patients, sending educational material to your patients to improve their wellbeing, negotiating with insurance on contracts, testing other modern technology to enhance business efficiency, and much more. Need help? Call iCareBilling today and get a free consultation on how we can improve your office workflow, revenue, and collections.