Medical billing plays an increasingly important role in the financial success of small practices. As a healthcare provider, accuracy in this aspect is essential. With ICD-11 and billing updates of 2023, medical practices must stay on top of medical billing best practices to maximize revenue and minimize billing errors.
This blog post will highlight five valuable tips for ensuring accurate medical billing and coding in small healthcare practices.
5 Best Tips for Accurate Medical Billing in Small Healthcare Practices
These are tips for improving small medical practices’ bottom lines through medical billing best practices.
1. Streamline Medical Billing Processes
Technology can be a crucial component in streamlining the billing process. With technology, patients can pay in multiple ways via seamless digital transactions at their simplest level.
Modern technology, such as medical billing software for small practices, allows doctors, staff, and administrators to share information more smoothly. Additionally, some medical software systems can assist in automating steps in the billing process. For instance, you can use these systems to obtain medical codes and to ensure that your medical claims comply with insurance reimbursement guidelines.
The good thing is these software bots are provided with basic data entry procedures to ensure that the required data is captured from Electronic Medical Records (EMRs) and added to the billing system correctly. By doing so, you will save staff time and avoid unexpected denials.
2. Ensure Accurate Patient Information
Knowing your patients’ basic information when filing medical claims is equally important. Even the slightest mistake can result in rejecting or denying your claim. To ensure accurate and clean patient information on all your claims, follow these steps:
Collect patient information: Gather the details like the patient’s age, gender, address, and phone number. If it’s necessary to send a bill to a collection agency later, ask a patient for photo identification at the first appointment.
The best medical billing and coding tip — verify the patient’s insurance coverage and eligibility. As a provider, you must perform this process before giving any services. At the time of service, clarifying the patient’s financial responsibility is essential. Also, obtaining accurate insurance information in advance will help prevent claim rejections and save time. Don’t forget to ask about copays and remind the patient of them.
Nowadays, most practices use advanced medical billing and coding software. Patients only have to provide their information once with this software and don’t have to do it every time they go to the hospital or clinic.
3. Practice Proper Coding
Current Procedural Terminology (ICD) and International Classification of Diseases (ICD) codes change frequently. That is why staying updated on these code changes is crucial to ensuring accurate billing.
A lot depends on accurate coding and conformity to regulations regarding medical billing. Healthcare, as a highly regulated sector, does not exempt small practices from adhering to rules. These regulations address the medical billing and coding of healthcare and physician services from various sources.
- Health Insurance Portability and Accountability Act (HIPAA)
- Medicare and Medicaid guidelines
- Certain health insurance companies may require specific billing and coding requirements.
Furthermore, adhering to the coding standards established by regulators and payers makes healthcare data more accurate and consistent, facilitating effective communication among healthcare providers. Thus, maintain record-keeping of coding changes to prevent claim denials and underpayments.
On the other hand, upcoding and unbundling are also serious concerns in medical practices. Training and regular audits are therefore essential. You can prevent unintentional or intentional errors by training your staff on proper coding guidelines and the importance of ethical billing practices. You must also conduct regular internal audits to avoid coding discrepancies, ensure compliance with the law, and maintain its integrity.
Remember: Upcoding and billing issues can damage your healthcare business irreparably, so take these preventative measures to safeguard it.
4. Manage Claims Effectively
According to Kaiser Family Foundation analysis, some Healthcare.gov marketplace payers claim denials rates as high as 80%. If this continues, insurers could lose millions in revenue.
Meanwhile, inefficient claims management processes increase the cost of processing claims, impacting the bottom line. Several factors contribute to this problem, but these are the most common:
The act of duplicating billing: Failure to confirm that a service has been reported or reimbursed.
Lack of documentation: There were incorrect, illegible, or incomplete records of the procedure or visit, making verifying and completing the claim difficult. Thus, the biller should follow up with the provider in these cases.
Explanation of Benefits (EOB) not attached to a denied claim: Insurers that still require physical claims might fail to attach the EOB to a denied claim, making it more challenging to identify and fix the error.
Denial codes or claim number references were missing or unclear on a denied claim: Most insurers accept electronic or online appeals. In these cases, no EOB is provided; instead, claim numbers and denial codes are provided to explain the reason for the denial. However, a missing or unclear code can make locating and correcting the problem more difficult.
So, what are the medical billing best practices for these issues?
If any information on claims needs to be more consistent, complete, or clear, double-check the claims before submitting them. Make sure to follow up with the insurance company for any errors they encounter after submitting the claim.
You must resubmit a denied claim with the attached EOB to avoid errors such as those listed above. Sometimes, an insurance company will return a claim without an EOB or denial code.
This situation makes it challenging to identify and correct errors. You can contact a company representative to find out which portions of the claim were problematic or if you can send an EOB.
5. Outsource Your Medical Billing Process
One of the most effective medical billing and coding tip is outsourcing.
According to a recent publication, outsourcing allows you to focus on other aspects of your business while providing customers with high-quality services. It’s similar in healthcare organizations. Outsourcing medical billing and coding is a cost-effective way to eliminate in-house staffing.
For small practices, hiring a company that offers all aspects of medical billing services is beneficial. The right company can assist you with insurance billing, coding, and collection efforts. Ensure they have advanced technology, like medical coding software, which can simplify your billing process.
Tap Into Our Expertise
This 2023, learning some medical billing best practices will help you ensure financial stability and compliance. While there are many ways to streamline medical billing, the best way still depends on your practice’s particular needs.
At 5 Star Billing Billing Services Inc, we offer high-quality medical billing services for small practices! Our goal is ALWAYS to meet your medical billing and coding needs, saving your staff time and resources.
Want to learn more about the benefits of outsourcing your medical billing? You can also get more medical coding and billing tips from us by scheduling a call with our experts today!