7 Medical Billing Tips

7 medical billing tips

1. Verify your patients’ information.

When you’re filing medical claims, knowing your patients’ basic information is as important as recording how you cared for them. Incorrectly completing the basic information sections on the HCFA and UB-04 forms is as likely a source of claim rejection as inaccurate CDT-10 codes. Take these steps to ensure accurate, clean patient information on all your claims:

• Ask for patient demographics and contact info. Yes, really. The simple act of explicitly asking for this information can make a difference. In fact, how you ask the question can make a substantial difference. If you ask, “Is your information up to date?” or “Has your information changed?” your patient might not be sure how recent the information is. If you ask, “Is your address still X?” instead, the patient can immediately identify errors.
• Verify patient health insurance. Just as patients might not know that the basic information on their records is outdated, they might be unaware that their insurance information is out of date. During intake, ask the patient to provide their insurance ID, policy number and (if applicable) group number. Once you have this information, contact the insurer to verify the patient’s coverage and benefits. Ask about copays and remind the patient of those as well.

2. Set clear patient payment terms.

Let’s say you’ve taken the first step and know your patient’s insurance will cover your services with an $80 copay. You’ll want that $80 from the patient sooner rather than later. Take these steps to make that happen:

• Clearly state what patients owe and when and how they should pay. Don’t assume that patients will know how much their copay will be as you check them in. Instead, tell the patient they have a copay during their check-in, and request the payment then and there. Ask for upfront payment, but be flexible if the patient can’t afford to pay immediately.
• Establish a patient communication workflow. Let’s say a patient can’t afford their copay at the time of their appointment. In that case, you’ll need to keep in touch with the patient until they pay. You can do so either through payment reminder letters or electronic reminders. If you go the electronic route, automate the delivery of these reminders based on how long the patient has owed payment. Monthly payment plans may be an acceptable alternative when patients can’t pay immediately.
• Send patient statements as necessary. Ideally, your patient will owe a copay, and their insurance will take care of the rest. But it isn’t always that simple. If the insurer denies some or all of the claim, payment for the remainder falls on the patient. To convey this news, send patient statements detailing the claim and which parts the insurer declined to pay. The insurer should send the patient an explanation of benefits (EOB) with the statement for further insight.
• Figure out how to address nonpaying patients. Unfortunately, patients who don’t pay their bills are inevitable. You’ll need reliable workflows in place to reach these patients and successfully solicit payments. Decide which communication channels feel most tactful and effective for reaching the patient. Determine when denied claims should be appealed to the insurer instead of sent to the patient (who can then appeal denials on their own). Make sending patients to collections an absolute last resort. 

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3. Make sure your claims include the basics.

If you handle your medical billing in-house, rejected claims could take you several weeks to resubmit. All that lost time means your cash flow won’t be quite what you need it to be. The thing is, many claim rejections result from simple errors you could easily catch at the outset of the medical billing process. Before you file your claims, check that the patient’s demographics and insurance information are accurate. Make sure the correct provider is indicated. This way, you won’t wind up with a rejection due to simple errors.

4. Double-check all your coding.

Another major source of claim rejections is incorrect medical coding. Since there are staggering numbers of five- or six-digit codes for medical services, it’s easy to code a claim incorrectly. 

Where humans can’t check for errors, that’s where claim scrubbers come in. These automated programs, which often come with third-party medical billing services and clearinghouses, match all codes on your claims with the actual services for which you’re billing. The program will flag any mismatches as errors and tell you how to correct them.

Of course, like all software programs, claim scrubbers aren’t perfect, so you’ll want an expert medical coder to look at the findings before making the changes. The combination of machine efficiency and coding expertise vastly improves medical billing and coding outcomes.

5. Determine how you’ll handle rejected and denied claims.

No matter how much work you put into rigorously checking your claims before filing, rejections and denials are inevitable. What happens next is up to you and can have a noticeable impact on your cash flow and billing costs.

The good news is that handling rejected claims is usually simple. Look at the errors the payer has indicated, then correct them and resubmit the claim. This process is typically quick and pain-free, even if the time between resubmission and payer reimbursement is long.

Denied claims is another matter entirely. When claims are denied, payers are supposed to provide you and the patient with EOBs to explain the issue. However, payers may forget to include EOBs with their denials, leaving you in the dark. Even if they do provide EOBs, you have a question to answer: Is filing an appeal worth the time and money?

While you might be able to offload the burden of appealing a denial to the patient, it’s not uncommon for practices to do so on the patient’s behalf. In fact, third-party medical billing companies often include denial management with their services. In many cases, outsourcing your medical billing to these companies can prove well worth the price tag.

6. Use medical software platforms and outsourced billing companies.

With the best medical software platform, you can streamline your front-office staff’s billing tasks. The practice management software (PMS) side of medical platforms, for example, can significantly expedite the intake and patient payment tips detailed earlier in this list. Most medical software platforms pair PMS with integrated electronic medical records (EMRs), which can auto-populate your claims with service details that improve your coding. 

When you outsource your medical billing, you entrust your entire cycle to an external full-time staff of medical billers and coders instead of your own front-office staff. In doing so, you free your front-office staff’s time for patient-facing matters and hand over your revenue cycle to highly qualified experts. These experts often have access to powerful, exclusive claim scrubbing and denial and rejection management tools.

7. Keep up with your field.

No matter what experts and software you have in your backyard, stay tuned to shifts in your specialty and the general medical world. That might include changes to state medical laws and updates to CPT-10 and ICD codes. Such alterations can lead to changes in your medical billing and coding process big enough to result in rejected or denied claims. To avoid that fate, keep an ear to the ground. The result will be an easier medical billing process for your team and more revenue for your practice.

The best medical billing services

Streamline your operations with some of the best medical billing services available, including:

• AthenaCollector: This service provides reports that show how practices rank in comparison to each other, which allows them to identify both weaknesses and strengths. AthenaCollector also includes real-time analytics, streamlines claims and appointment tasks through a workflow dashboard, and provides recommendations for corrections. This service is easy to use and optimal for medical billing. Learn more in our review of AthenaCollector.
• CareCloud: One of the most flexible services, CareCloud is perfect for practices that want the freedom to choose what functions they need and whether they want to outsource all or some of their tasks. The revenue cycle management (RCM) process includes a variety of features that practices can choose from, including claim scrubbing, centralized billing, denial resolution and payment processing. CareCloud’s Collective IQ is an automated billing system that will help practices detect errors in coding, which can speed up the submission process. Learn more in our review of CareCloud.
• DrChrono: Practices searching for a service to help improve their workflow will likely enjoy DrChrono’s 48-hour turnaround time on denials, RCM task manager and organized billing components. The service provides practices with experts who check coding to ensure documentation is correct, as well as account managers who provide performance reports each month. DrChrono’s platform allows practices to spend more time on their patients and less time on billing. Learn more in our review of DrChrono.

Danielle Fallon-O’Leary contributed to this article.