Medical billing practices keep getting more complicated because of the mishmash of private insurers, public insurance programs, and federal and state regulations around cost containment and allowable expenses. For a busy medical practice, trying to get everything right can be a time-consuming and frustrating experience. Many physicians and other healthcare providers spend as much time sorting out billing and doing paperwork as they spend providing care to their patients. Fortunately, there are simple and proven ways to increase medical practice revenue without spending any more time on paperwork.
1: Code Procedures and Visits Properly
One of the main reasons why medical practices lose out on revenue is an ICD-10 coding error. A coding error could make a big difference in the level of reimbursement that you receive for an office visit or procedure. To make things even more complicated, different insurers have different coding criteria for making a diagnosis. In the example of lobular pneumonia, there are four possible sets of coding criteria under the ICD-10 system. One insurer might require diagnostic criteria based on the systemic inflammatory response system while another may set their claims around documentation of the sequential organ failure assessment score. If your staff uses the wrong code based on the insurer’s requirements, chances are good that the claim will get denied. With each new contract and each insurer, everyone has to stay on top of the criteria of diagnosis and take the time to verify that the right diagnostic process and code has been entered into the claim.
2: Ensure Claims Have Complete Documentation
Our cloud-based software helps eliminate missing information in the insurance claims process. In the example above of lobular pneumonia, an insurer might deny a claim because you did not provide the metabolic panel test results or the complete blood count laboratory tests. This could make a difference in the level of payment or whether you get paid for the claim at all. Some insurers require that you provide evidence of systemic effects of pneumonia, such as hypotension, hyperglycemia or thrombocytopenia. Others may require you to submit a positive blood culture that is indicative of bacterial infection. This is in addition to the X-ray results. Our chart auditing and claims overview process ensures that all of the valid information is submitted with each claim. By submitting all of the required information the first time, we take a proactive stance on denial management.
3: Get Ahead of Denied Claims
A simple coding error or lack of sufficient backup information could trigger an insurer to deny a billing claim. Denial management should be a key part of your billing process. Although it is wise to create steps in your billing in order to avoid denied claims in the first place, some may still be denied by the insurer even if you do everything possible to avoid the problem.
Denial management has four key steps. The first is having an associate research the reason why the claim was denied. We offer this review service so that your medical practice administrators do not have to spend their time on it. The second step of denial management involves identifying errors. Staying on top of the ICD-10 codes is the best way to avoid denied claims. In the third step of our process, we track and follow the unpaid claims. We do this on a routine basis in order to prevent lost revenue. The final part of our process is the mitigation of future denied claims. This last key step of denial management may involve record auditing, conversion of paper records to electronic medical records, and automating your data entry.
4: Audit the Coding in Your Medical Billing
The ICD codes change on a regular basis. If the administrative staff in your medical practice are not up to date on the ICD-10 codes, this is another one of the ways to increase medical practice revenue. Training your staff and providing them with resource materials can be time-consuming and expensive. We do this for you with routine auditing of the coding in your medical billing.
For example, if you have a patient with diabetes mellitus type 2, the billing for each visit is critical to proper reimbursement for your time, and the testing or procedures that you perform. If the patient has macular edema as a complication of their disease, they will need more frequent checkups with their endocrinologist, ophthalmologist, and other specialists. One simple error in the coding of the office visit could trigger a denied claim for the care of their macular edema. In the case of diabetes mellitus caused by an underlying condition with moderate non-proliferative diabetic retinopathy, the ICD-10 code of E08.331 ensures that you get reimbursed for the care related to their macular edema. Using code E08.33 or E08.339 could result in a denial of the claim for their macular edema care.
As a part of our auditing services, we make recommendations for corrective actions. This allows your medical practice administrators to submit the correct codes the first time, preventing payments from being delayed. Our reports also show you where you may be losing out on reimbursement due to coding errors.
5: Identify Under-Billing
Another one of the ways to increase medical practice revenue is to avoid under-billing. For example, a person with diabetes mellitus type 2 may have avoided visiting a physician, resulting in complications that require a longer initial assessment. This type of office visit takes more time than an office visit for a person who has had routine care for their condition. If it takes you two- or three-fold the amount of time to evaluate, assess, and diagnose the patient and order additional tests, you need to ensure that you are billed properly for the extended office visit. Our auditing process identifies areas of under-billing so that you can be fully reimbursed for the time that you spend on complex cases.
6: Convert to Electronic Medical Records
Conversion to electronic medical records is another one of the top ways to increase the revenue in your medical practice. While most medical practices have made the conversion, there are still some that have yet to complete this process. A cloud-based electronic medical records system allows us to audit, verify and correct erroneous information. The ideal electronic medical record software features workflow processes that include the steps that facilitate the approval of claims. Our electronic medical record conversion services improve your practice’s efficiency.
7: Set Up Automated Workflow Processes
Setting up automated workflow processes ensures that you and your staff do not miss an essential part of the documentation process. It also identifies errors as they are made, which reduces claims denials. For example, an inversion of a patient’s date of birth could trigger a denied claim for a mismatch. Our automated processes identify such errors at the time they are made. Within two minutes, you can enter all of the information required for a claim for most types of patient encounters.
To learn more ways of increasing your revenue through proper billing techniques, contact us: