One of the most unique and challenging aspects of the American healthcare delivery system is the process of billing and collecting for medical services.  Becker’s Hospital Review reported on one study by Health Affairs that revealed the amount of time practices spend interacting with health plans equates to more than $68,000 per physician each year. What’s more, practices also incur additional costs, such as billing software, to get reimbursed.  To minimize these costs, successful practices must continuously evaluate their billing and coding processes to keep pace with the ever-changing landscape of third-party reimbursement.  

Start at the Beginning 

It may sound simple, but effective billing practices start during the very first interaction with a patient, usually before the patient arrives in the office.  Collecting accurate insurance and benefits information at scheduling paves the way for a smooth and efficient collections process down the road.  

Once benefit information has been obtained, verification of those benefits is essential so that office staff can determine the patient’s specific plan type, network status, coverage allowances and out-of-pocket responsibilities. Careful eligibility verification is key to minimizing collection delays and claim denials 

Accurate eligibility and verification processes also confirm a patient’s co-pay and coinsurance responsibilities, which allow staff to educate patients and request point-of-service payments. Effective point-of-service collections decrease the likelihood of bad debt later in the Revenue Cycle process.  

Coding is Key 

Coding is a critical aspect of the billing and collections process and is essential to the practice’s bottom line.  A successful coding department must actively seek to minimize denials and maximize reimbursement. A few strategies for achieving this include:   

  • Generating Accurate ClaimsConduct a coding review of a small sample of your cases annually. Utilize the results to focus on opportunities for improvement among the staff.  
  • Providing Ongoing Training to Staff – Based on results of the coding audit, provide regular training to staff members to improve coding accuracy and to provide insight on specific requirements within various payer contracts  
  • Ensuring Legal and & Contractual Compliance by conducting annual or semi-annual audits.  

Time is Money  

Accurate billing and coding processes result in more timely payments from patients and payers. Identifying Key Performance Indicators to evaluate the timeliness of these aspects of your Revenue Cycle will provide keen insight into your processes.  Metrics such as Days to Bill, Days in AR, Billing Turnaround Time, and Speed to Payment can highlight areas in need of improvement.  

Contact us to learn more about how Practice Partners can help you analyze your billing and coding processes to improve your practice’s bottom line.