Best Practices for Medical Billing

by | Published on Dec 26, 2014 | Medical Billing

Best Practices for Medical Billing
Share this:

The 2013 Practice Productivity Index, a survey which covered more than 5,000 U.S. physicians found that 58% of doctors 9% spend at least one day per week on paperwork instead of treating patients. Best practices for medical billing are necessary to help physicians strike the perfect balance between productivity and quality of care. Let’s look at the lifecycle of a medical claim starting with the work that goes into patient documentation.

Documentation of Patient Details

The medical record contains facts, findings, and observations about the patient’s health history along with the communications with and about the patient. The front office desk collects the patient’s demographic information prior to consultation and the accuracy of information is a critical factor in providing efficient patient care and billing for services rendered during the patient visit.

Every patient encounter should be documented and include the following information:

  • Registration – Create a new patient account or update an existing account using the information provided in the registration form.
  • Demographic entry – Input all the required information
    • First and last name
    • Insurance policy number
    • Address
    • Gender
    • Marital status
    • Date of birth
    • Employer/school
    • Phone number
  • Appointment scheduling – A structured appointment scheduling system improves revenue and increases patient satisfaction. Professional patient scheduling services ensure that the process is easily manageable and works smoothly for both provider and patient.
  • Insurance verification The information provided by the Online Eligibility Report includes the Insurance Provider name, Policyholder name, status, patient’s name, DOB, office co-pay, account number, and the healthcare provider’s name. Verify whether the insurance information is correct and up-to-date before a patient’s appointment, and follow-up on any changes or problems. It must be also determined if pre-authorization is required. Insurance benefits must be explained to the patient.
  • Claim generation, submission and follow-up – Once the physician has seen the patient, the diagnostic and procedural codes have to be noted correctly and submitted for billing. A super bill has to be generated with all the patient details. The bills have to be submitted to the clearing house and follow-up to ensure reimbursement.

The front office in a physician’s office is a busy place with phones ringing, fax messages coming and going out, and patients checking in and checking out. The patient’s first impression of the physician is usually formed within the first few minutes of entering the medical office. Inefficiencies waste time and effort, result in errors, affect productivity and the bottom line, and frustrate patients, staff and physicians.

That’s why busy physicians rely on professional companies for all the activities related to medical billing and coding. A medical billing company can handle everything from appointment scheduling, patient enrollment, insurance verifications and authorizations to claim submission and resolution. This helps the healthcare professional strike the perfect balance between productivity and quality of care.

Rajeev Rajagopal

Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.

More from This Author