The provision of high-caliber medical treatment to patients should always be the number one priority for any physician or medical practice. The revenue that is generated by the institute is necessary for the establishment and upkeep of a well-trained team, which includes physicians, technical employees, and medical equipment. These individuals and items are all dependent on the revenue that is generated by the institute.
The vast majority of healthcare services are paid for by medical insurance, and the reimbursements that a clinic or practice receives from insurance companies are what drive their revenue. As a result, the maximization of the practice’s reimbursements should serve as the secondary objective in order to ensure the practice’s success.
The procedure for healthcare reimbursement involves a number of intricate phases, and at each stage, there is an inherent possibility of a delay. Patients are burdened with invoices that they do not fully comprehend and, as a result, they frequently do not pay these costs. When billing delays occur, there is a possibility that your revenue will be in danger. This is a simple truth.
Complications with the reimbursement process frequently result in inaccurate documentation and coding, which eventually leads to a claim being denied. It’s much simpler to say you won’t make those mistakes than it is to really do it, and many of the hazards are intricately connected to how you manage your revenue cycle.
Despite how challenging it may be to detect gaps in your RCM, implementing these habits should have a favorable influence on your revenue stream.
Pay Attention to Coding
When patients are billed for the services that have been rendered to them, codes are utilized. After being converted into standard codes, the patient’s diagnosis, treatment, and services received during their visit are then used for billing purposes. Errors can occur in the form of a non-specific diagnosis, inaccurate coding, missed coding, upcoding, and under-coding, among other possible variations. This may result in a delay in the processing of your reimbursements, denial of payment, or just partial payment. Therefore, the person who is in charge of coding and billing needs to have a solid understanding of medicine and the ability to make quick and accurate references to the patient’s information and medical codes.
Claim and Denial Management
When it comes to evaluating the claims that have been submitted, insurance firms must adhere to highly stringent standards. A significant number of claims are turned down due to inaccurate patient information, inaccurate provider information, problems with the coding, or other information that is missing. You should always review the claims a second time before submitting them in order to prevent wasting the time and effort that will be required to change the claims and then resubmit them.
When a claim is submitted with coding mistakes, an erroneous insurance number, or a patient policy that has been canceled, the claim will be rejected. When it comes to evaluating the claims that have been submitted, insurance firms must adhere to highly stringent standards. A significant number of claims are turned down due to erroneous patient information, information about the provider, issues with the coding, and inadequate or absent documentation. You should always review the claims a second time before submitting them in order to prevent wasting the time and effort that will be required to change the claims and then resubmit them.
Improving one’s performance can be accomplished by staying current with the various amendments that are made to healthcare rules. You should always maintain track of the annual revenues, find out the reasons why they are increasing or dropping, and stay up to date on the changes that are being made in the coding and billing procedures. It is best for teams to get together on a regular basis to talk about problems that are frequently experienced and the solutions to those problems. It cuts down on the amount of time needed to interact with every member of the team whenever a problem arises or circumstances shift.
It is a typical oversight to overlook patient eligibility verification and authorization for returning patients, which is one of the most significant processes in the process of revenue cycle management. Patient eligibility verification and authorization is one of the most critical steps.
One survey found that over 80% of providers check the eligibility of their patients, but that only around 25% of those providers reverify the same patients for subsequent visits. Prepare yourself for claim denial in the event that there is a change in the patient’s coverage but the insurance information is not updated.
Even if the patient insists that their insurance has not changed since their last appointment, it is still a good idea to make a copy of their card and keep it on file. This is excellent practice. Before submitting a claim, verify that the information matches what is in your practice management system.
One of the best strategies to increase the amount you are reimbursed for your services is to negotiate or renegotiate a contract with a payor. For instance, entering into a preferred provider agreement with the payor can increase the number of patients you see, particularly if you consent to the terms of payment set forth by the payor in advance of rendering services.
Patients will often make the decision to see a physician inside their network because reimbursement rates are already established within the contract. However, compensation for treatments rendered by providers who are not in the insurance plan’s network might be difficult to navigate due to the fact that many insurance policies base their payments on Medicare’s prices.
Minimize Human Errors
If your revenue cycle team is overworked with tedious responsibilities such as verification, eligibility, patient registration, filing claims, and rewriting denials, then they will have a greater propensity to make errors. In point of fact, a number of studies have shown that attempting to multitask at the same time reduces overall productivity.
According to the findings of a study conducted at Stanford University, performing multiple tasks at once results in lower levels of productivity. According to the findings of the study, individuals who are exposed to multiple streams of electronic information at the same time have a more difficult time focusing their attention, remembering information, and transitioning from one task to another than individuals who work in a monochromatic environment. In addition, engaging in multiple tasks at the same time can reduce your accuracy as well as your cognitive ability, which can be disastrous when dealing with complex RCM procedures. Find a partner who can give dedicated revenue cycle and back office support to your existing team so that you don’t overload your revenue cycle team. Alternatively, invest in automated solutions so that there is no room for human mistakes at any point in the process.
Strengthen Your Administrative Team
As soon as a patient schedules an appointment with your organization, the finance teams in your company immediately begin to work. The team immediately starts collecting patient information, which will become the foundation of billing and collections. Because of this, it is essential that your front-office personnel collects the most accurate information possible about patients. When collecting patient and coverage details, your administrative team should be as specific as possible. This includes information such as coverage dates, service coverage, whether your practice is in-network or out-of-network, information accuracy, maximum allowable visits, co-pay and deductible, and other details.
Denials of coverage may occur if the personal information provided or the coverage itself is wrong. In the event that the claim is denied, the staff will need to spend time revising it and resubmitting it. If the information is not updated, you may find that in the future you have even more trouble getting reimbursed for your expenses.
When it comes to maintaining good billing hygiene, it is preferable to file a claim that is nearly perfect the very first time. You do not want your workers to waste valuable hours redoing claims since this will just slow down the process of getting reimbursed for your business.
When a patient comes in for medical assistance, you should always perform a brief check to determine whether or not they are eligible for insurance before giving any care. If you don’t do that, the insurance company might leave you with an unpaid claim, or the patient might not be able to pay their expenses on time. Either way, it’s your responsibility to make sure it gets done. This is yet another problem that, if it occurs frequently, might negatively impact the revenue of your practice.
It is highly recommended that you move to outsource if you are currently reliant on temporary personnel for coding and billing and if you frequently find errors and delays in claims. When you outsource your medical coding and billing to particular dedicated companies, it will assist ensure that claims are filed accurately and on time, and the companies will also handle any claims that are denied or rejected. They will have the most modern equipment, be familiar with the most recent rules, and save you money on time and labor costs. When a billing partner such as Aplus RCM takes care of this component, you are free to devote your full attention to the treatment of your patients.
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