Home Health 3 Key Steps to Improve Medical Billing Process & Avoid Claim Denials

3 Key Steps to Improve Medical Billing Process & Avoid Claim Denials

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Medical billing is a tricky process that requires a good deal of time to get done. Re-working medical bills can consume a lot of your time and resources. When it comes to medical billing services, many variables have to be looked after meticulously.  If your staff is not familiar with the ins and outs of insurance billing, they may be taking a hit on your revenue.

Being able to handle the ever-changing healthcare industry and the increasing regulations is challenging. It can be even more difficult when you face claim denials. Denial rates have been steadily rising in the post Covid era. The key to avoiding these denials is having a robust payment system. Moreover, it is knowing how you can better manage your operations and reduce risk of claim denials.

The claim denials in medical practice are equivalent to leaving a lot of money on the table. The cost being denied can be a serious threat to your practice. You need to make sure that you have an optimized process that can prevent claim denial rates. There are several ways you can do this but here are few ways to avoid claim denials and increase revenues:

Prior Authorizations is the key to avoid denials

Prior authorization is the process by which a third party performs a medical review of your patient before authorizing coverage. The purpose of prior authorization is to ensure that the insurance company has enough information. Authorize to make an informed decision on whether or not you should provide a particular service requested by your patient.

This review is important because it protects both you and your patient from fraud and denials. However, it can be frustrating if a patient doesn’t have all of their documents in order.  Any discrepancies between you and the insurance providers may also lead to too much loss on rework. If you’re not sure how to get started with prior authorization, here are some tips:

  • Keep records of all previous medical visits in one place (such as a computer system/EHR) so that you can easily access them when needed.
  • Make sure that all appointments are documented in the system.  In this case, no one person will have to remember everything about every patient’s history at each visit.
  • Ask patients for detailed information regarding their health conditions, medications, allergies, and other relevant information.
  • Ask them which insurance plan they have and who is covering it.

Using an automated scrubber based on payer-specific edits

This is one of the easiest ways to avoid denials and increase revenues. All you need to do is hire a good medical billing company in USA.  They will create an automated scrubber which will be able to detect any issue with the claim, before it reaches your payer. The scrubbers can help with CPT compliance as well. For Example; using a current procedure terminology (CPT) code with modifier 25 when the patient receives two services on the same day by the same provider. This will tell the payer that two separate services were rendered on the same day and payment can be made for both claims.

You can seek assistance from any medical billing company in USA  . They can use an automated scrubber based on payer-specific edits to make sure you’re only sending bills that are accepted by your payers. This is especially important if you have multiple payers, or if you have a large number of patients with complex billing needs. Scrubber checks for discrepancies between what you billed and what was paid out by your primary insurance company. If there are any inconsistencies, you will receive an alert so you can correct them immediately.

Running periodic A/R Reports

A/R reports are an essential tool for medical billing departments. They are a great way to track your transactions and identify fraudulent activity. You can run an A/R report every day, or weekly or bi-weekly, depending on how often you need it. The more frequently you run the report, the better your chances of catching any discrepancies before they occur.

In the A/R report, you can look for any discrepancies in patient information that could be associated with negligence. For example, if a patient is having surgery and needs to be admitted to the hospital but is not listed as an outpatient, it may be time to investigate why this is happening. If you find that some of your patient’s information is missing or incorrect, this could mean there was some sort of data entry mistake made by one of your employees.

Properly run periodic A/R reports will help you to identify any problems with your billing, coding and collection processes. It will also give you an insight into your revenue collections.

Key Takeaways

An optimized billing process plays a critical role in streamlining medical processes. However, there is always an overlooked need for optimization to increase revenues and avoid the denials. Implementing these key strategies in your medical billing process will help you lose your hard-earned money. It is not difficult to identify the loopholes in your work and rectify them quickly. If you are not sure where to start, hire reputable medical billing services. They will manage everything and you can focus on your practice.

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