How Outsourcing Medical Billing can Minimize Claim Denials and Maximize Reimbursement

by | Published on Jul 4, 2018 | Medical Billing

Outsource Medical Billing
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This is an update on the August 2, 2011 blog “What Are the Services Offered by a Medical Billing Company?

Just like any other business, healthcare providers need competent cash flow management to get properly reimbursed for services provided. An efficient medical billing process is essential to ensure smooth submission and follow up on claims with health insurance companies for appropriate reimbursement. However, with increasing emphasis on value-based documentation and strict processing guidelines established by payers and government agencies, medical billing has become a major challenge. Outsourcing revenue cycle management to an experienced HIPAA-compliant medical billing company will ensure that the process of translating healthcare services into claims is handled by experts in the field. Partnering with a knowledgeable medical billing service provider can help physicians minimize denials and get paid quickly and efficiently.

Reliable medical billing companies successfully handle a gamut of tasks across the entire revenue cycle management (RCM) process – from patient scheduling, insurance verification and medical coding, to accounts receivable (AR) management and financial reporting. They are experts in working on all types of software to provide end-to-end billing solutions that cover the following processes:

  • Patient scheduling and reminders: Patient registration is the initial phase in the medical billing process. This complex process requires collecting patient demographic information, appointment scheduling, and checking of health payer coverage. The first step involves patient appointment scheduling and setting up of the account for billing and contact. In technologically advanced medical billing companies, professionals trained in scheduling and registration processes utilize sophisticated online software to book appointments send out reminders, verify patient information, and reschedule appointments. Efficient medical appointment scheduling improves revenue, enhances patient satisfaction, and maximizes physician efficiency.
  • Patient enrollment: This involves electronically enrolling patients by providing demographic and insurance information collected from the hospital registration system. Proper enrollment is necessary to ensure that insurance companies have access to patient information which will help prevent claim denial and payment delays.
  • Insurance verification and preauthorization: Obtaining insurance verifications is the most critical step in the medical billing process. Medical billing companies have experienced insurance verification specialists who can provide customized services for each provider. They will call the insurer directly to verify if the patient’s coverage is active as well as details such as patient name, ID number, date of birth, copayments, deductibles, coinsurance, exclusions, lifetime maximums, claim mailing address, and subscriber information. They will verify all primary, secondary and tertiary coverage and document patients’ out-of-pocket costs to determine the patient’s financial responsibility. Comprehensive patient eligibility verification prevents claim denials due to erroneous patient information and also improves overall patient satisfaction.
    Another critical aspect is obtaining preauthorizations for specific physician-ordered medical tests, clinical procedures, medications and medical devices. Timely preauthorization is important to prevent treatment delays or denials. Pre-authorization requests along with supporting medical documentation are submitted via telephone, websites, or fax. Pre-authorization experts can also track and monitor payer authorization rules and policies as well. Efficient insurance authorization services relieve physicians of this grueling and time-consuming administrative task.
  • Medical coding: Reliable medical billing companies also have AAPC-certified coders on their team. These experts will assign the right diagnostic and treatment codes as well as modifiers on claims based on the information in the medical record to describe the patient’s symptoms or illnesses and the services provided. Skilled coders are knowledgeable about the CPT, HCPCS and ICD-10 codes which are numerous and constantly changing. Their medical coding services help avoid claim denials.
  • Charge entry and claim submission: Charges for services performed are entered in the patient’s account. Appropriate charges are assigned to the medical codes entered. Established outsourcing companies have charge entry experts who can handle a high volume of transactions efficiently. The charges are reviewed for accuracy before for billing. After the charge entry, claims are submitted electronically to the insurer for payment. Medical billing specialists are knowledgeable about complex claim submission processes and review and edit claims for errors before sending them.
  • Insurance payment posting or billing and reconciling of accounts: This critical step involves posting the payments in lieu of claims in the healthcare provider’s medical billing system. The EOB (explanation of benefits) or ERA (electronic remittance advice) sent by the insurance company to settle claims is posted immediately into the respective patient accounts. Amounts collected from patients through checks or credit cards are also correctly accounted against the claim to ensure proper closure.
  • AR management: Efficient AR management is necessary to minimize reimbursement issues and accelerate cash flow. Medical billing service providers have dedicated A/R personnel who work with both payers and patients to collect payments. These experts will thoroughly evaluate the practice’s accounts receivable position to indentify denied claims, unpaid claims, and low payments. Efficient AR management involves follow-up on unpaid claims and posting payments and denials quickly following receipt of remittance advice. A reliable medical billing company would know payer timelines for modifying/appealing claims and take appropriate action to correct and re-bill claims denied for billing errors. Outstanding claims will be reviewed regularly, and corrected/reprocessed according to payer rules. Correcting claims quickly will reduce “days in AR”.
  • Financial reporting: Medical billing outsourcing companies also provide customized financial reports on a weekly/monthly basis. This allows physicians to track their key performance indicators (KPIs) and monitor the health of their practice. This will help them make strategic decisions to improve their revenue.

A medical billing company with years of experience in the field is well-positioned to provide cost-effective solutions for individual physician offices, family practices, clinics, and hospitals. They would be well-versed in all insurance carrier claim requirements and can handle billing for all medical specialties.

Julie Clements

Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.

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