Do You Want to Improve Medical Billing Efficiency? Focus On These 3 Stages

How to Improve Medical Billing Efficiency - PracticeForces

Decidedly you want to improve medical billing efficiency for your medical practice, and that’s why you have clicked on this article. The start of 2023 is the perfect time to identify how to improve medical billing efficiency at your practice. Let us preface this by saying that you know your medical practice the best. However, the medical coding and reimbursement realm is complex and dynamic, making it one of the most challenging aspects of managing a medical practice.

The tips in this article are based on our experience as a medical coding and billing service. Over the last two decades, we have worked with hundreds of medical practices and payors. For ease of understanding, the tips are divided into three stages of patient interaction.


Stage 1-Improve medical billing efficiency before the patient visit

The process of improving medical billing outcomes begins when the client contacts your medical office for an appointment.

Verify patient demographics and insurance information for every patient!

You must have precise information on the client before they visit your medical office. New patient registration and patient appointment booking are vital stages for ensuring that you collect and verify the patient’s demographics and insurance information. This process can be made easier for the client by enabling a patient portal on your practice website. Alternatively, you can ask patients to send you their details via email.

Verifying these details for existing patients is necessary because your patient may have changed jobs and now has a different insurance provider. They may now have additional insurance coverage from the spouse.  The patient may have opted for a different insurance plan with the existing insurance provider, impacting the deductibles or copay expenses. Double-check the policy number, subscriber information, and billing address of the patient with the health insurance company.

If you are a new practice, invest in automating coverage verification to improve medical billing efficiency. It will also save your staff significant time as they no longer have to be on the phone speaking to payors. That time can instead be spent on speaking to the patient-centric tasks such as clarifying the cost of treatment and collecting payment.

Inform patients of the cost of service before the visit/ or before the medical service on the date of the visit

High-deductible health plans become more and more common. However, your chances of collecting a payment, even within the first month, reduce drastically after the patient leaves your medical office. Pediatricians and primary care physicians have the lowest success rates in patient balance collection. According to an Athena survey, only 6% of outstanding balances over $200 are ever collected.

Timely and accurate insurance eligibility checks will ensure that your patients are well aware of the cost of the treatment and you minimize the risk of ‘Surprise Billing.’  Transparency in medical cost estimates also improves patient loyalty and satisfaction.

Share your collections policy upfront. 

Open communication with patients is essential for efficiency in patient collections. Your medical practice’s financial and patient collection policy must be shared with all new and existing patients.  The collection policy should be on your business website and visible in the patient waiting area.  Ensure your patients understand the requirement to pay the ‘patent liability’ amount before the service date. (Recommended reading – Overcoming Upfront Patient Balance Collections).

Ensure your staff understands where prior authorizations are required

You will not be paid if a referral/authorization is required but not obtained.  Do your pre-cert procedures before you provide service. Remember, prior authorizations and referrals must happen before the service is rendered.


Stage 2: Improve medical billing efficiency during the patient visit

Offer multiple payment options

If the patient has a limited plan or an exclusion, collect upfront. Providing multiple patient payment options will improve collections overall and reduce days in AR ( accounts receivables), bad debt, and write-offs. Patients should be informed of multiple payment modes, including using an online payment app, a credit card on file, or staggered payment plans for high-cost medical services.

Obtain ABN for claims that may be denied

An advance beneficiary notice or ABN is a written declaration that a provider gives to the patient if there is a risk that Medicare may not cover the medical service. In the absence of payment by Medicare, the liability of paying the medical bill falls on the patient. Recommended reading – Use Advanced Beneficiary Notice As A Patient Collection Mechanism


Stage 3: Improve medical billing efficiency after the patient visit

Focus on medical documentation 

You can obtain authorization for a test/procedure, and then when the claim is processed, it is denied.   The top denial reason for that is ‘medical necessity not met or not documented.’ You will not be paid if the medical necessity is not documented to the insurance company’s satisfaction.  Please document in detail the necessity for the test/procedure you are ordering.  You must spell out why a test/procedure is being ordered.

Also, the days of billing every patient visit to are over. If you have documented a treatment plan that requires additional trips to the office relating to a medical problem addressed in the first visit, you will not be paid for the subsequent visits.  You have already done the evaluation and treatment plan and are now providing the treatment you already evaluated.  Additional evaluation is not required unless there is a documented change, significant decline, new problem, etc.

Follow specific payor guidelines for medical billing.

Payors have specific guidelines for certain tests and procedures. For instance, if 3 months of physical therapy is required before treatment, you must document that the patient received physical therapy and behavior modification which did not resolve the issue.

Electronic bank reconciliation of payor payments

The process of revenue management does not end with the claim approval. You must ensure that the correct claim amount is deposited in your account based on your contracts with the insurance payors.  One payment best practice is to ensure you accept electronic fund transfers (EFT) from all payors. EFTs will make it easier to collect and reconcile your bank payments versus the value of claims submitted. (Recommended reading – 5 Ways to Minimize Underpayments in Medical Billing).

Review and follow up on aging claims

Dedicate a staff member to follow up on delinquent claims. It could be a billing error or even a simple miscommunication with the insurer or patient. Once you zero in on the problem, your reimbursement can be claimed. Read these tips to minimize your accounts receivables aging.

Evaluate your denied claims data

The first step to minimizing claim denials is understanding the top causes of claim denials and then taking corrective steps to minimize the top contributors.   Here is a list of the top 13 reasons for claim denials in medical billing. If your healthcare practice is experiencing an increase in claim denials, it is recommended that you work with an experienced medical coding and billing company.

If you need assistance with improving medical coding efficiency, we are here to help. Our experienced medical coding and billing staff will track all claims submitted and identify cases of underpayment and denials for correction and resubmission. Our robust reporting and analysis will help you understand revenue leakages as per payor and practice location to prevent future underpayments and denials.  We have had many successes in recovering underpaid claims by working with payor reps on behalf of our clients. Contact us for a free consultation on minimizing underpayments and reducing your accounts receivables (A/R).

Parul Garg, CEO and co-founder of PracticeForces, has significantly contributed to the growth of over 1,000 U.S. medical practices through her expertise in medical billing and coding since the company’s inception in 2003. With a background in Computer Science and an MBA in Human Resources, her leadership and AAPC-certified coding skills have been pivotal in managing the company’s operations effectively.

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