Top 5 Healthcare Billing Tips for Beginners

Top 5 Healthcare Billing Tips for Beginners

New to healthcare billing procedures? Invest in these 5 beneficial tips to ensure efficient management of your medical billing cycle.

Healthcare billing wastes approximately $17 billion in errors and denied claims yearly. With 86% of these errors being administrative there is a lot behind the scenes that need to be addressed.

Here are a collection of items that can be observed and given attention to make sure that you do not contribute to those shocking numbers.

1. Attention to Detail is Essential

It comes down to a simple truth, claims that do not get filed properly do not get paid out. It is essential that requirements on any claim are properly met and that all codes are followed.

Particular areas are very common for error and will easily get a claim denied and returned. These include:

  • Incorrect Patient Information
  • Name, DOB, Insurance ID
  • Incorrect Provider Information
  • Address, Name, Contact
  • Duplicate Billing
  • Did not verify if a service has already been reported
  • Poor Documentation
  • No EOB (Explanation of Benefits) on Claim
  • Missing or Unclear Denial Codes or Claim Number References

This is why double-checking all small details before a submission is important, as is following up with a representative at the insurance company that provides coverage to be sure of any errors they may encounter.

While attention to detail is very important, it is wise that you file claims every day. Do not dedicate just a couple days of the week to filing the claims. If they build up in a pile things can be missed, work can pile up, and they can turn into payment issues.

Filing every day will ensure that each claim gets deserved time given to it and that it gets sent out promptly.

2. Involve All Parties

What was once a tiring and at times difficult process, enrollment with payers has become a much easier task.

This is thanks to several systems that have been developed by the Council for Affordable Quality Healthcare or CAQH.

Open and Clear Communication

Establishing a strong relationship with a patient from the get-go with a patient will lend itself to the best results when it comes to the entire process of billing and potential collections.

It is no surprise that many people do not fully review all of the details of financial responsibilities when it comes to their overage. These things include; total out-of-pocket and deductible.

At the start of the doctor-patient relationship, it is wise to take all of the insurance information not only to verify illegibility but also to review all costs with the patient.

In addition to the insurance information creating a complete profile for any patient is one of the best ways to promote an efficient billing process. This profile includes:

  • Full Name
  • Birth Date
  • Work Information
  • Contact Numbers (Multiple # if possible)
  • Social Security

3. Technology is Your Friend

There is a great deal of truth in the saying, technology makes life easier. Making the process, by implementing a patient portal, easier for patients is a win-win. This promotes an active role for the patients and streamlines interaction.

A patient portal can provide access to:

  • Payment History and Activity
  • Medical documentation such as x-rays and shots
  • Insurance documentation and post-op instructions
  • Ability to send and receive secure messages to and from healthcare practice

Initially establishing this system requires a bit of work. Once it is implemented, however, the improvements to the billing and collections process will outweigh any time that was spent.

4. Best Practices and Procedures

Having a system in place that is the same for every patient that comes into the practice is a way to ensure that every claim will be submitted accurately. This can be helped by developing a formal contract to use in every situation.

E&M Coding

Standing for Evaluation and Management coding, this coding method enables a healthcare practice to bill on the total time spent with a client. This is not only face-to-face but also non-face-to-face time.

With proper documentation, the time spent will also change the code level as it lends to the indication of how complex the medical process was.

Some of the items covered under E&M Coding include:

  • Reviewing Tests to Prepare For A Visit
  • Ordering Medications, Tests, and Procedures
  • Counseling the Patient and Family or Caregiver

The idea was that patient care goes beyond the room in the practice. There is a great amount of time that is spent preparing for the appointment and counseling for the patient to leave.

Formal Contract

Having a formal contract that breaks down all of the details, such as services rendered and payment options, in an easier to understand way makes the process much easier for the patient.

Having this done in a formal contract promotes an air of professionalism for the practice as well. This is another place to have their information collected too.

Doing this also requires that all on the staff are properly and effectively trained. You chart out all the steps of the billing process, make sure that you have the workers for each step and they all have an excellent education.

5. Always Improving

With a field that is always growing and changing a healthcare provider needs to do the same. If a practice wishes to keep maximizing its efficiency and output they need to keep education and development at the top of their priorities.

Keeping track of unpaid accounts provides more than just information about what is owed to you. The data recorded allows you to evaluate how effective your collections process is.

Establishing a particular segment of the year to observe at a time, quarterly, for example, gives items to compare. Compare the first quarter one year to the same time the year previous and you will effectively have an A/B testing situation.

More data collection surrounds account behavior, that means by not limited to:

  • Late Payments
  • Frequent Information Changes
  • Consistent Declined Payments

If you collect enough information you can develop a system to recognize patterns and send specialized reminders. Continuing to see these behaviors would be an indication to take a step in the direction of outsourcing to collections.

Staying informed is important because medical regulation is constantly changing. Not only could you run into slower processing but you will also, more than likely, encounter more returned claims that need editing.

A Multifaceted Approach to Healthcare Billing

The healthcare world is a place of intricacy and detail. Healthcare billing is no different. By developing a system of standards and giving proper time to each claim you will ensure proper service and little to no denials.

To continue learning even more about the healthcare service and administrative world be sure to stop by the blog soon!