Busy physician practices often fail to notice small medical billing errors and this usually proves very costly in the long run. A recent study by the Center for American Progress found that providers spend $282 billion annually on billing and insurance – related costs and that about half of this amount – $248 billion – is excessive. Researchers at PwC’s Health Research Institute (HRI) predict that patient billing and policy and regulation will be top priorities for providers in 2020. While partnering with an expert medical billing service provider can have a positive impact on revenue cycle management, practice leaders need to be aware of common medical billing hurdles and the strategies to overcome them.

  • Neglecting insurance benefits verification: Not verifying insurance benefits prior to rendering services is one of the costliest mistakes that a practice can make. It can result in denials and significantly impact your bottom line.
    Health insurance eligibility verification should cover the following:

    • Checking whether the patient’s insurance coverage is valid at the date of service
    • Verifying benefit options – confirming co-pay, co-insurance, dependent insurance, and other deductibles
    • Verifying prior authorization requirements
    • Understanding in and out-of-network services

    Registration and eligibility errors are the root cause of one-third of denials, according to a recent Medical Economics article. Hiring an insurance verification specialist will ensure thorough patient benefit verification and decrease risk of claim delays and denials while promoting timely and accurate payments.

  • Not discussing payment with patients: Talking about money is not easy, especially with patients. Physicians need to have productive conversations about medical costs, especially as patients are becoming increasingly responsible for more of their own health expenses. A Medical Economics report recommends that the best strategy is not asking whether they want to pay their bill now, but to offer a choice of two options to pay: by check or credit card. Educating patients on basic insurance and billing terminology can also improve the patient-provider relationship. Remaining transparent regarding medical procedures and patient out of pocket costs are key.
  • Not filing claims on time: Payers have specific deadlines for claim submission. Claims that fail to meet this deadline will not be paid, with the denial reason of “timely filing exceeded”. These denials have no appeal rights unless it can be proven that the claim was filed by the submission deadline. Medical billing companies use a clearinghouse to send claims in to payers. The payer receives the files in one large file for review and payment. If the practice is denied for timely filing, the biller can search the clearinghouse’s website to confirm that the claim was not just sent, but accepted by the payer. In this case, the denial can be appealed. The team in a professional medical billing outsourcing company will be aware of major payers’ timely filing deadlines and ensure that their clients’ claims are filed on time.
  • Not running aging reports: Not following up on outstanding insurance claims can affect the practice’s bottom line. It is imperative that the Accounts Receivable (A/R) Aging report is reviewed on a regular basis. The AR aging report is a great indication of a practice’s financial health. Continually monitoring and checking claims can identify payments that have not been received. The report breaks down claims based on the number of days they’ve been unpaid. Usually, claims take about 15-30 days to get paid. Running the report after the 30 day mark will indicate trends, issues and red flags.
  • Not reviewing contracts with payers: Inefficient and infrequent payer contract management can leave money on the table. Practices can maximize revenue by analyzing terms and assessing payer performance. In other words, healthcare providers should strive to improve contract management. A Revenue Cycle Intelligence article points out that practices can use contract and performance data to convince payers to give the practice a more favourable rate. Steps in this process include:
    • checking which payers have the highest impact on total revenue based on the covered patient population
    • analyzing fee schedules and payment processes to understand each payer’s performance
    • presenting rates paid by different payers for a code for commonly billed services during negotiation
    • Getting input and agreement from the organization’s key stakeholders organization to ensure that right questions are asked during negotiation

Reviewing payer contracts at the beginning of the year is a great step to identify any changes from the previous year and to also note the filing deadlines for the year ahead. Notating when contracts are due will also help plan for contract renegotiations. (www.medicaleconomics.com).

Designating a dedicated medical billing company to handle revenue cycle management is the best way to avoid these issues. In fact, recent reports indicate that medical billing outsourcing is growing rapidly. Working with a company with vast experience in the field can reduce billing errors, save money on in-house training, and improve cash flow with error-free medical claim submission.