Many medical practices are having a tough time sustaining and improving their performance and practice revenue as the healthcare environment continues to evolve. Trying to juggle decreasing resources with increased provider and patient demands makes it difficult to keep practices growing financially. Aligning with hospitals and health systems through affiliate or employment arrangements can be financially beneficial to some medical practices, but it doesn’t ensure optimal performance, growth, or improved practice revenue.
What can you do to start bringing in more revenue? The first step is to understand the obstacles standing in your way and then address them to start seeing growth and improvement.
Manage Claims Properly
Approximately 80% of all medical bills contain errors, and because of how strict insurance companies are about correct medical billing and coding practices, they’ll likely be rejected. The cycle of submission, rejection, editing, and resubmission can take weeks, often resulting in providers waiting for months before receiving payment for their services.
Because of the wasted time and effort involved in editing and resubmitting claims, it’s important that claims are accurate and complete the first time. This involves inputting the information correctly and double-checking claims for any possible errors before submitting them.
Some of the most common sources of error include:
● Incorrect patient information: Name, date of birth, insurance ID number, etc.
● Incorrect provider information: Address, name, contact information, etc.
● Incorrect insurance information: Policy number, address, electronic payer ID, etc.
● Duplicate billing: Failure to verify that a service has already been reported or reimbursed.
● Poor documentation: The provider submitted an incorrect, illegible, or incomplete documentation of a procedure or visit, making it more difficult to verify and complete the claim. In these cases, the biller should contact the provider for more information.
● No EOB on a denied claim: For insurers still requiring physical claims, they may fail to attach the Explanation of Benefits (EOB) to a denied claim, making it more difficult to spot and correct the error.
● Missing denial codes or claim number references on a denied claim: Many insurers allow electronic or online submissions of appeals and corrected claims. Instead of an EOB, these claims are returned with a claim number and denial codes to explain the source of error. If these codes are missing, it can be more difficult to spot and correct the error.
To minimize billing problems, be sure to double-check claims before submitting them and communicate with the rendering provider if any information is inconsistent, incomplete, or unclear. After submitting the claim, follow up with a representative of the insurance company and keep up-to-date on any errors they may have encountered.
When resubmitting a denied claim, make sure to check the attached Explanation of Benefits (EOB) in addition to the possible errors listed above. It’s possible that an insurance company will return a claim without an EOB or denial code attached, which makes it more difficult to identify and correct any errors. If this occurs, contact a representative of the company to ask if they can clarify which portions of the claim were problematic or if they can send the EOB.
Telehealth in Nephrology care should no longer be avoided. While there will always be a need for in-person visits, especially in regard to Nephrology, Telehealth offers tools that help Nephrology providers and their patients achieve goals that were previously unattainable. With simpler care-coordination, Remote Patient Monitoring, and improvements in follow-up care, there is no question that there is a place for Telehealth in Nephrology care.
Know When to Outsource
Patients, current trends in medicine and proper staff management are always top of mind at a practice, as are recent rules about coding standards, insurance companies, and billing regulations. With so much to keep up with, billing tasks may slip through the cracks, resulting in rejections, denials, and underpayments that cost medical practices time and money.
Despite their best efforts to implement proactive billing practices, many healthcare providers still find themselves lagging behind. The time and labor involved in tracking down debtors, submitting and editing claims, and staying on top of current regulation is costly. In response to the multiplying rules and regulations and in an effort to cut labor costs, many practices have outsourced their medical billing and coding to third party specialists. For many, it’s an effective way to increase revenue and regain control over their billing.
Some of the benefits of outsourced medical billing include:
● Dedicated specialists: Medical billing and coding companies have dedicated staffs of medical billing specialists, whose sole job is to ensure that claims are filed correctly and denied claims are resubmitted properly. Because of their specialized experience and duties, they can pay attention to the minutiae medical office employees can miss in the bustle of their daily duties.
● Fast submissions: Highly trained staff members can submit claims much more quickly and with greater attention to detail.
● Greater focus on patients: Once they’ve eliminated the time spent on billing and staffing concerns, doctors and nurses can better focus on their patients.
● Up-to-date standards: Medical billing companies are compliant with the most recent health care laws, and they are required to stay up-to-date with the most current regulations in order to meet the changing demands of serving hospital-based specialty practices.
The easiest way to find out if you have inefficient medical billing processes is to contact Tower for a FREE practice assessment. To learn more about how we can help your medical practice enjoy fewer denials, higher reimbursements, and a boost in practice revenue, contact us today for more information.