Optimizing Your Revenue Cycle: Strategies for Proactive Medical Billing

Several elements of healthcare reform have evolved over time, including value-based compensation models, recurring changes to the rule engine for medical billing services, and other federal laws. In light of these continual changes, physicians must stay up to date on the latest developments. As a result, they must receive ongoing training in medical billing and coding rules. Staying outdated is a problem for medical practitioners because they cannot compromise the quality of their professional services due to income loss. To minimize this trouble, medical practitioners should implement the proper tactics to stay in compliance with medical billing trends while also improving the quality of care services. This blog will provide you with tried-and-true strategies for optimizing  proactive medical billing services in order to maximize revenue.

Claim Management Process

According to a recent survey, about 80% of all medical bills involve errors. Because of strict insurers policies, these inaccurate medical claims are denied and rejected. Although medical billers can reapply these claims in order to challenge an unpaid bill. The cycle of claim submission, rejection, and resubmission, on the other hand, takes a long period.

Medical billers should build a proper claim management process in order to save providers valuable time. They should deploy competent personnel and equipment to monitor all paid and unpaid claims. To file accurate claims on the first try, use smart medical billing software solutions. They should also make certain that accurate information flows throughout the claim submission procedure.

Before filing claims, they should double-check the claims to identify any potential information errors. This will ensure that payers and patients obtain clean claims that can later be successfully reimbursed.

Minimize Medical Coding Errors

Medical codes serve as the foundation for medical billing services. A medical bill's objective is to standardize medical care and diagnostic procedures into standard medical coding protocols. For various medical operations, these medical codes are categorized as CPT, ICD-10-CM, and HCPCS Level II categorization systems.

Although it is a common way of describing medical operations, errors can also arise in this aspect. It contains the most common errors, such as erroneous, mismatched, or missing codes, among others. These inaccuracies are easily detected by clearinghouses and payers. However, some medical coding errors are highly intricate and result in unfavorable outcomes.

For example, if medical coders utilize less detailed ICD-9 codes rather than extremely specific ICD-10 codes, the claim will be denied or rejected. If medical coders employed inappropriate modifiers, upcoding or undercoding, such errors can cause your claims to be rejected or denied further down the road.

Payer Contract Enforcement

Payer underpayment is another major issue for any practice attempting to optimize collections. According to MGMA industry estimates, payers generally underpay medical practice's by 7-11%. Then there's the issue of various payers paying varying amounts for the same quality of service. Clearly, if payer contracts are not monitored and enforced successfully, the practice will suffer a significant income loss. However, tracing each underpayment down is a significant challenge, and here is where robust technology comes in handy. You can also opt for the following approach to avoid these issues:

• Each of these contracts must be correctly interpreted and configured in the practice management software.
• Define clearly if you have any thresholds for under or overpayments.
• While posting paper EOBs, the software should provide you with the right permitted for each CPT on the claim: any claim with an exception outside of the threshold should be marked with a specific claim adjustment reason code (CARC) and forwarded to the dispute queue/ bucket.
• Apply no threshold to a significant payer trend: $2 per claim for 500 claims in three months is a lot of money. It is totally worth it to pick up the phone and call a provider representative to get this resolved.

Outsourcing - The Optimal Strategy!

Due to the ever-changing healthcare industry, coders and billers must constantly upgrade their skills and concepts to keep on top of the changes and avoid losing money. With the advent of EMR and advanced practice management software, the prevalent idea is that billing and collection standards will be higher than ever before, with every claim being paid out precisely and collected on time.

According to industry sources, independent medical practice's are still losing up to 30% of potential revenue due to inefficiencies in the billing and collection process.

This occurs because the rejection and denial rate remains excessively high, with nearly half of denials never being handled, resulting in a 5-7% loss of potential revenue. When you have a high number of denials, your revenue can quickly become stuck in Accounts Receivable, causing a significant impact on your cash flow. As a result, you can follow these proactive strategies to make these simple modifications to your current medical billing process and increase your revenue by 25-30%.

Else you can also outsource your medical billing services to the professionals who are experts in following these proactive strategies. 24/7 Medical Billing Services is a major medical billing service provider that has optimized the billing and collection procedures for several practice's, allowing them to maximize revenue and eliminate cash flow problems.

See also: Should Providers Consider Outsourcing Medical Billing Services?