For a modern medical practice, few business operations carry the same level of importance as billing. While it is essential to have a health revenue cycle to be able to balance the costs of providing healthcare in this day and age, it can be very difficult to ensure that your practice is being paid its due. With providers being reimbursed by third-party payers right after the patient has left, it’s reasonable to expect a lag between rendering services and receiving payment. Also, there is the matter of claims being rejected or denied for a number of reasons.
It all comes down to using the best practices to get timely and complete payments for the services you’ve rendered. Some experts in the field had the following tips on dealing with payers.
Don’t leave out information
The information you send in must be complete. The claim needs to be sent to the right payer, but in a delegated payer environment this might not always work, because any payer, risk-bearing group or health plan could be responsible for reimbursing your practice. Claims could get passed around and this would cause long delays.
Make daily submissions
Billing out daily is a smarter approach than waiting for the insurance companies to pay you, or fail to. It’s better to have system in place that lets you follow up on outstanding claims until they get paid. Make sure you know beforehand what the insurance company requirements are for individual claims, and that these have been met during the filing process.
Involve the patient in the case of rejection or denial
Oftentimes there is no better advocate for an insurance payment than the holder of the policy, so arranging a three-way call can be very effective. This usually leads to a positive claim outcome, and if the call is static, you can get in touch with a supervisor.
Set up a standardized process
It is helpful to have a flow chart outlining precise steps leading up to billing and collections. Specify the actions to be taken at each step, and throw in the right staff for each of these. Also, don’t forget to train them.
Employ a billing service provider
Hiring one of the reputed medical billing service companies in your area can lift a huge burden off you while you work to heal patients. Lower-level employees will do their best, but a billing company can give you the right assurances, and deliver on them.