Medical Billing Tips And Best Practices

Don’t Make Critical Medical Billing Mistakes

The medical billing process is arguably the most crucial business operation for many hospitals, ambulatory surgery centers, or other healthcare facilities. Inefficient billing practices, billing mistakes and ineffective follow up can add up quickly, costing hospitals and healthcare facilities thousands of dollars in lost revenue.‍

Good news is there are steps you can take today to improve your billing practices, saving your practice or facility from lost revenue.

Increase Efficiency For Your Practice

Change Your Practice’s Procedures now with these steps to improving your billing operations!

Ensure claims are being submitted electronically, instead of paper. This can greatly reduce wait time and errors

If you are in-network:

Understand your payor contracts and medical coverage policies.

  • Payors often vary in payment rules and policies, such as reimbursement rates and processing times
  • Payor guidelines and rules are readily available on the internet in most cases
  • Appeal line items are not allowed at agreed-to rates

Have copies of your contract and rate agreements – you can get them from your provider representative.

Always have copies of provider manuals. There are available online and contain valuable information relating to claims and appeals procedures and other important issues like the handling of recoupments and overpayments.

‍If you are out-of-network:

Ensure that all patients sign an enforceable assignment of benefit

Have all patients sign Financial agreements as to balance bill responsibility

Summary Plan Document authorization

Require Pre-disclosure forms

Take advantage of technology:

  • Medical billing software advances can significantly reduce staff workload and increase efficiency
  • Have a workable EHR system

‍Dealing with Insurance Companies and Health Plans

Insurance companies find ways to avoid or delay payment for legitimate medical claims. As a result, health care professionals are stuck between choosing to write off otherwise collectible debt or fight a long and expensive battle to appeal. We recommend these tips when dealing with insurance companies to ensure you receive your rightfully owed reimbursements.

‍Take a look at our tips when dealing with insurance companies to ensure you receive your rightfully owed reimbursements:

1) Submit clean and completed claims containing proper modifiers and including authorization numbers on claim forms. Incomplete claims can waste resources and bog down the claim process.

2) Hold insurance companies accountable. When talking to an insurance company:

  • Ask for a reference number for the phone call
  • Ask for a higher-level employee. Not everyone at an insurance company has the same abilities to help you.

3) When a claim has not been paid or responded to after 30 days, file a first level appeal. If claims are denied, ensure that you exhaust administrative remedies by filing two timely appeals. Failure to do so could preclude you from filing a formal complaint against the health plan.

4) For clinical denials for lack of medical necessity or experimental, consider filing external, independent appeals which are allowed in most jurisdictions

  • Personnel outside the insurance company decide these appeals
  • Don’t forget that you can always file complaints with insurance regulators (for non-ERISA Plans) and with the Health Bureau with the US Department of Labor (for ERISA Plans)

The Patriot Group Is Your Answer!

Billing processes can be a burden on staff, taking up valuable time and resources. The Patriot Group will provide fast, friendly and affordable billing options while keeping your practice safe and compliant. With highly trained professionals, The Patriot Group provides enhanced consistency and higher recovery rates than competing billing providers.

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