Medical billing and claim payment are a critical stage of the revenue cycle. Even the smallest of errors in either can lead to major interruptions in your practices stream of income. Correcting a problem once it has occurred further takes away more critical resources that would be better spent treating patients or expanding your practice.

The following steps will help you improve each step of the revenue cycle.

  • Verifying information and insurance coverage as part of the scheduling process.
  • Setting up policies to collect fixed balances and making sure patients are informed of their responsibilities.
  • Creating accurate claims with verified information and accurate coding.
  • Setting up best practices for dealing with claim denials and claim rejections.
  • Establishing follow up procedures to streamline the payer process.
  • Generating clear patient statements to make sure patients are informed of any outstanding balances.
  • Efficient payment processing policies to ensure a consistent revenue stream.
  • Scheduling routine analytics to stay informed of the revenue cycle and catch any potential negative patterns early.

Accurately Verify Information When Scheduling

When a new patient schedules an appointment at your practice you will need to collect their insurance information. Even existing patients might have a change in policy or coverage that could lead to the claim being denied. So, it’s always a good idea to verify and update their information before the first appointment, or before each scheduled appointment.

Collect Fixed Balances

Things like copays and outstanding balances are a part of many coverage plans. Sometimes a patient can’t pay their copay or they were billed for things like medical supplies or specific treatments and have gone more than 30-days without paying the outstanding balance.
Setting up a collections policy, and making sure that incoming patients are aware of their financial responsibilities during the verification process certainly helps. Though you might want to also contract a collection agency. That way you can outsource the collections process for any delinquent funds without having to pass this duty on to your administrative staff.

Accurate Claims Procedures

Claims creation is a crucial part of the medical billing process. Coding errors, missing information, bundling code discrepancies, and special service codes can all lead to a claim being denied or rejected. Proper staff training and orientation certainly help. Some people will turn to special medical billing software with sometimes mixed results. Though most small practices and solo practitioners prefer to outsource medical billing and claims creation to a third party like Operant Billing Solutions. That way you know that all the claims creation procedures are being handled by specialists who have the training and experience to enter the information correctly the first time. This also frees you up to focus on patient care and potentially attracting new patients.

Dealing With Claim Denials & Claim Rejections

Even something as simple as a coding error can lead to claim denial. Having staff on hand or an outsourced agency like Operant Billing Solutions available to review denied claims and correct potential errors will not only speed the revenue cycle process, it will also spare you or your staff from having to waste patient treatment hours on correcting denied claims.

Claims rejections can be due to a variety of reasons. Sometimes they are simple coding errors or missing information that needs to be entered for the payer or clearinghouse to accept the claim. Though in some cases it might be a lapse in coverage or a treatment that isn’t specifically covered under the patient’s policy. This is why the verification process is so important in the first step of the revenue cycle.

Frequent Follow Up

If you have a claim that has been rejected, denied, or for some reason delayed. In a situation like this, it’s important to follow up promptly. With certain policies and types of claims, there might be an expiration period for filing a claim.

This can be a major loss of resources, only to once again end up with a denied or rejected the claim. Being able to outsource to a firm like Operant Billing Solutions, reduces the chances of this happening in the first place and further frees your time for more fruitful tasks.

Keep Track Of Patient Statements

A patient with an outstanding balance from a deductible, coinsurance, missed copay, medical equipment bill or other costs can cause a significant interruption in the revenue cycle. Keeping track of patient statements and setting up alerts for missed payments. Here again, outsourcing to a third-party firm like Operant Billing Solutions will save you time as well as spare you having to make first-person follow up calls.

Receiving Payment For Services Rendered

Most of the time a paid claim that is accepted by the payer will be direct deposited into your practice’s accounts receivable bank account or sent to you as a paper check. This typically includes an explanation of benefits or electronic remittance advice, which explains what aspects of the claim were paid. If your patient owes a deductible or is responsible for outstanding funds, it will also be documented. With Operant Billing Solutions handling your medical bill procedures, this part of the process is streamlined to help you maintain a more consistent revenue stream.

Applying Analytics

Without proper analytics in place payment data and other aspects of the revenue cycle can feel chaotic. It can be hard to know just how fiscally healthy your practice is at a glance if all you have is an uncollated spreadsheet. It’s best to set up a policy to collect reports and interpret data at specific times. Quarterly reports are the absolute minimum amount of time you should go between analytics cycles. Though most successful small practices find that monthly or even bi-weekly analytics reports help them understand how the revenue cycle is performing as well as catching negative revenue patterns early.

Conclusion

As you can see, a consistently strong revenue stream requires a multifaceted approach at every step in the process. It certainly starts with accurate information capture at scheduling as well as effective coding and accurate medical billing practices. Though this is still just the “tip of the iceberg”. Effective follow-ups, audits and analytics will further help identify areas where your practice can improve as you strive for maximum growth.