The medical billing cycle starts as early as the patients register with a provider and demographic details and insurance plan information are entered. Then it moves to eligibility process, entering billing codes for the services, payment follow-ups and posting the payment details.
However, critical leaks coming in the way of this billing cycle can severely affect the revenue of the providers. To complete this billing cycle productively, it is important to scrutinize all the stages, identification of gaps and leaks, setting up of revenue goals and deciding a strategy to achieve it.
Here are a few steps to streamline the medical billing cycle:
Review the current workflow
Before starting to restructure the billing workflow, evaluate current work practices, only then it’s possible to identify loopholes in the system. Gauge the competency of the billing staff and their understanding of the recent updates in coding and billing. Analyze the supporting IT infrastructure and software tools and look for required upgrades.
Identify the revenue leaks
Payment denials and poor follow-ups can be classified as the two major reasons for revenue loss. Calculate clean claims and denied claims ratio, dig deeper and bring out the reasons for payment denials. Similarly, jot down clearly the major causes of payment denials and what can be done to avert the objections from the payers.
Integrate billing processes and automate
Integrated practice management system or electronic medical record system combined with computer based coding and billing tools bring accuracy to the processes. Patients’ health records available at a centralized database provide better context to billing staff. To expedite the billing process, automation of the system is a must.
Managing billing resources
The staff responsible for billing should be trained and proficient in the latest changes and upgrades. For instance, any changes in HIPAA electronic transaction standards or upgrade in coding version could cause disruption in the payment process. Therefore, make sure that the system and the staff are up-to-date.
Improvements in the backend billing processes
Accurate coding and submission of clean claims to the insurance carrier covers only half of the billing cycle. The current billing system requires a consistent two-way flow of communication between the provider and the payer. The payment capture, A/R follow-ups, posting payments received, providing the required documents and appealing of denied claims are some of the back end billing chores, fine-tuning which bring positive results.
Reporting gross revenue
“If you can’t measure it, you can’t manage it”, said a management consultant. It is important to set achievable performance indicators, plan a strategy and then compile weekly, monthly or annual performance reports. If these reports are supported by statistical comparisons from the previous financial reports and elaborated in graphs and charts, it helps to analyze and identify glitches in the cycle.
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