Maximize Your Medical Practice’s Revenue with These 6 Billing Tips

While your patients’ well-being is your number one priority, your practice needs a consistent, steady stream of income to provide your patients with the best quality care and treatment.

In the world of healthcare today, medical practices leave up to 30% revenue untouched as a result of billing process inefficiencies and claim rejections. An effective revenue cycle management process is the goal of the vast majority of providers. Revenue cycle management directly affects your personal income, as well as the income of your employees.

With all of this in mind, many healthcare providers are left with the same question: How do you maximize collections from patient services billing?

NCDS Medical Billing knows modern healthcare revenue challenges all too well, and has identified the top medical billing tips to improve your cash flow and increase your revenue stream to provide your patients with top notch care.

1. Clarity of Terms

Before doing anything else, review your current medical billing rules and terms and revise them to encourage clarity. Between physicians, medical billing coders, insurance companies, patients, and other responsible parties, there are many actors to coordinate. Your terms must be crystal clear to each party, and all must understand their role in payment responsibility.

If your terms are abundantly clear, your practice minimizes the opportunity for errors in billing. Creating clear, consistent terms will ultimately lead to a streamlined medical billing process.

Clear terms are incredibly important for a big reason - ⅓ of insured Americans learn after receiving care that their health plan doesn’t cover as much of their medical bill as they expected.

Healthline data about healthcare surprise bills

This sticker shock indicates that patients don’t always have a clear picture of what payment looks like for their healthcare. Your job as their provider is to make it crystal clear.

How do you increase patient payments?

There are a few ways you can ensure you have clear terms to coordinate all parties to know their responsibilities and complete payments in full and on time.

Tips to Increase Patient Payments:

1. Provide patients clear information about repayment requirements. During new patient onboarding and continued patient visits, ensure they are fully up to speed on their payment responsibilities. Provide notifications to patients when payments are required, both when in office and through outreach after their visit.
2. Make sure a patient is aware of their copay responsibility before leaving the office. Ideally, they pay the copay before leaving.
3. Check up on patient insurance eligibility during each appointment or use electronic insurance verification. This helps avoid rejections.
4. Provide patients with an understanding of what payment types are available at time of service. A variety of payment options is helpful to ensure the majority of patients can access some payment method. Does your practice accept checks, credit cards, debit cards, cash, or installment plans? Share these options with your patients to help them understand what’s accessible.

2. Verify Patient Information

A simple yet effective way to make sure you’re collecting the payments you’re due is verifying your patient information. Cash is left on the table every year by healthcare providers due to inaccurate patient information. Many denials are a result of inaccurate patient information, and 90% of errors are preventable! Take this easy step to avoid preventable claim denials.

Have your patients verify the following information each visit:

• Name (for accurate spelling or any changes due to things like marriage)
• Current home address
• Mobile phone number
• Email address
• Insurance information

Collecting a photo ID is also important during a first visit. This will be helpful in the unfortunate event that a bill will need to be sent to a collections agency in the future.

Always know the most efficient and effective way to reach your patients. By having patients verify this information, you save yourself frustration, time, and money.

3. Increase Staff Training

Once you have well-structured billing terms and methods and you are regularly verifying your patient information, your staff must be aligned with your processes. Past that, ensuring your staff is up to speed on claims and medical billing coding is imperative. This training is crucial, and your whole office should be trained with consistent, up to date knowledge. To keep your practice functioning smoothly and with minimal billing errors, designate clear role responsibilities.

The many stages of medical billing that your team has to keep track of, visualized by Medbillingexperts.com

Additionally, when your team is fully trained on medical coding, your claims will be much cleaner when submitted. The industry First Pass Acceptance (FPA) claims average is between only 79-85%. However, the minimum First Pass Acceptance that you should be shooting for is 97% or higher. With a fully trained staff, you will have a higher likelihood of reaching that 97%.

A well-trained staff has many benefits:

• Properly verified insurance policies
• Correctly coded insurance claims
• Accurately determined copayments
• Consistency among code and term enforcement
• Expert understanding of medical codes

4. Improve Denial Management and Ensure Clean Claims

Despite a well-trained staff, accurate patient information, and an effective term process, denials still occur. Like we mentioned earlier, aiming for 97% or more clean claims is the golden rule, however, denials will still slip through. Because of the effect denials have on revenue cycle management, having a strong response to loss of potential reimbursement and claim denials helps keep your cash flow solid.

Denials put pressure on the cash flow of your medical practice. When your practice encounters denials, this increases your practice’s average number of days in accounts receivable. Your main strategy for denials should be prevention rather than response. Industry sources like the Change Healthcare 2020 Revenue Cycle Denials Index indicates that the denial rate has been increasing in recent years. In the third quarter of 2020, 11% of claims were denied upon initial submission.

Change Healthcare Denials Index denials trend

What we’ve learned from this increase in denials is where they’re coming from.

Change Healthcare 2020 Revenue Cycle Denials Index data

The Change Healthcare 2020 Revenue Cycle Denials Index shows us that about half of denials occur in the front-end, and most of those front-end denials originate in Registration/Eligibility

Change Healthcare 2020 Revenue Cycle Denials Index data

Going a step deeper, the main three reasons for Registration/Eligibility denials are:

• Coordination of benefits
• Benefit maximum
• Plan coverage

These data points show us that preventing denials is the best denial management strategy. However, when they do occur, we have some tips.

To maintain a healthy cash flow when handling denials:

• Prioritize denials when doing insurance follow-ups
• Work through denials within 48 hours of receiving
• Build a list of claim adjustment reason codes and group these by the actions taken to follow up
• Identify clear terms about what types of denials needs dispute and what types are accepted
• Create a template for different appeal types with standardized wording

5. Automation to Streamline Collection Processes

Manual workflows have the ever present risk of human error. It’s easy to accidentally input inaccurate data or send information to the wrong place.

If you’ve upskilled your staff, they don’t need to be weighed down with tasks that can be automated. Increase productivity and accuracy by automating aspects of the medical billing process where you see fit.

Where to implement automation in medical billing?

There are many opportunities for automation in medical billing, but below are a few examples:

Pre-Authorization

One beneficial area to implement automation is in the pre-authorization process. Over 11% of denials come from pre-authorization problems. By completing timely authorization, you can minimize these types of denials. We recommend automating pre-authorizations that require a medical review in order to get immediate authorization for most requests if payer criteria is met.

Medical Necessity Review

By automating medical necessity review, you can pull data right out of the electronic health record to quickly complete the medical necessity review and ensure all needed data makes the cut. This reduces human error and saves time for your staff.

Appeals

Where possible, automating appeals is a huge time saver that can also improve your cash flow. As we mentioned above, creating templates for similar appeal responses is a huge time saver. The next level in time saving is automating the appeals process using standard forms and templates.

Data and automation overall helps avoid common errors and mistakes in medical billing. When the process is not prone to errors, it helps collection and improves confidence and practice revenue. Additionally, when reports are more accurate, coders can better anticipate typical billing errors.

6. Partner with a Medical Billing Company to Improve Collections and Increase Your Cash Flow

Let's face it. Medical practices are busy tackling various issues like ensuring patients get the best care, upskilling, amd keeping on top of trends and rules in the healthcare industry. On top of all of that, medical billing and the collection process constitute a major job for your organization, and there is a lot to keep up with.

Outsourcing medical billing to an expert partner in the medical billing industry could significantly improve both your patients’ experiences and your cash flow. With our industry expertise, our dedicated team members understand all the ins and outs of the processes, and they are prepared to prevent any challenges like coding errors and unpaid claims.

Contact NCDS Medical Billing to get in touch with our medical billing experts who maintain an exceptional level of service. We’ll focus on improving your billing practices and patient collections process, maximizing your revenue and improving your financial health so you can focus on your patients’ care.

Questions?