Medical billing involves a variety of steps to be successful. Leaving out a step or not fully implementing one can lead to problems that could easily affect the finances of the practice. Following these 10 steps can help a practice achieve the success of prompt and accurate payment for their services.
Contracting and provider credentialing is the first step in a successful billing process. Work closely with a provider representative for a fair reimbursement contract with the insurance carrier. Once the contract is set the practice needs to be able to monitor on an on-going basis that the payment agreement is being met. Credentialing is the other half of this step that if not done timely and proper can lead to delays in payment or no payment from the carrier. Credentialing paperwork needs to be completed timely and follow-up on the status should be done regularly with the carrier. Know which carriers the provider can see during the credentialing process.
The next step involves gathering accurate demographic and insurance information. The front desk is key in this step for successful billing. Obtaining copies of identification and insurance cards is helpful in entering this information accurately into the practice management system. These copies can also be referred to later if there are address issues or insurance eligibility denials.
Verification of insurance coverage and benefits has become a critical step in billing a successful medical claim. In this time of high deductible health plans, health saving accounts, and economic issues (i.e., layoffs, unemployment), practices are seeing more patients whose insurance coverage has been affected by reduced benefits or no longer being eligible. Staying on top of eligibility will ensure a good financial situation for the practice. Verification is a step the practice cannot afford to skip.
Continuing education on insurance and coding issues for all staff in the office allows everyone to stay current with an ever changing healthcare industry. This knowledge will help staff make the correct collection decisions and physicians to make correct coding and charting decisions.
Once the visit has been completed the provider will need to complete the encounter form timely. This allows the practice staff to enter the charge in the practice management system in order to meet any time filing limits set by the various insurance carriers. During this time the staff should also have a process in place that ensures all charges have been captured. No provider wants to perform a service and not have it billed for.
A critical step that can make a big difference in denied claims is the scrubbing of the claim during the charge entry process. Scrubbing a claim is having the ability to review the carrier’s rules and regulations against the charge(s) before submission. This allows the practice to make corrections that would typically result in a denied claim saving valuable time spent reworking a claim later. Many practice management systems have the ability to scrub a claim or stand alone products that can be integrated with the practice management system are widely available in the industry today. This would be an investment that could easily pay for itself in time saved and claims paid.
After the charge has been completed timely and the scrubbing of the charge has been done submission to the insurance carrier should be prompt and efficient. The best way to accomplish this is through electronic filing to the carrier. Though not all carriers have the ability to accept electronic claims there are more each day who can. Filing this way allows the claim to reach the carrier faster while cutting down on postage costs for the practice. Electronic filing also allows the ability to receive confirmation that the claim has been received by the carrier.
As the explanation of benefits and payments come back from the insurance carrier prompt posting into the practice management system is the next crucial step in the successful billing process. As with electronic filing of the claim electronic remittance can contribute to the successful billing process with accurate and prompt posting of monies received. From prompt posting, either manual or electronic, claims can be followed up on, secondary claims billed, or patients billed for the balance.
Having the ability at anytime to know which claims are outstanding will allow for quick and easy follow-up with the insurance carrier. The ability to produce workable reports for the staff is critical in staying on top of outstanding accounts receivable. A process should be in place for consistent and prompt follow-up with all insurances.
The final step in a successful billing process is a clear and accurate statement to the patient. Statements should be sent to patients on a regular basis to keep them informed of the actions that have taken place on the account and make them aware of the balance that is now patient responsibility. Having a clear, easy to read statement will prevent unnecessary calls to the office for an explanation of the bill.
The medical billing process can be complicated but following these 10 steps can lead to a very successful outcome for the practice. The billing process involves everyone from the patient to the physician. When everyone does their part, success is felt by all. MedPro Solutions 850-474-8462
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