How to Create a Better Medical Claims Billing Process

The medical coding and billing process is, without a doubt, rather complex. Healthcare billing can take anywhere from a few days to several months, depending on the severity of a patient’s case. There are many ways to ensure better medical claims, which can ultimately increase acceptance and submission rates for first-pass claims. There are many ways to ensure that your billing process goes without a hitch from when a patient enters your practice. One of these ways is outsourcing billing operations to a third-party medical billing providers. Doing so removes a lot of overheads from your in-house staff, effectively diverting their focus to bettering patient care.

Better Medical Claims – A Tangible Reality

Medical billing is a complex and continuing process. It takes the most steam from your staff if you manage in-house billing operations. To properly understand why you should outsource your billing to a third-party billing company, we have created this guide highlighting some essential steps that help achieve a successful billing process.
Towards better medical claims processing – the first step is:

1. Managing Patient Check-ins

Patient check-in is the first time a patient is physically present at your practice; it is most important to perform this step right. A patient’s appointment data must include a precise notation of their demographics. This is in addition to the information regarding their insurance, including policy number and insurance payor details. Any information that can facilitate better medical claims submissions should be taken with details during patient check-in.

2. Verifying Insurance and Checking Eligibility

Even your regular patients must verify their insurance eligibility and information before making an appointment at your practice. The fact of the matter is that insurance information can change at any time. Before each visit, your first-contact staff (receptionists or appointment schedulers) must ask patients about their insurance information. Any changes in the insurance information can definitely impact the benefits or authorization information. Consequently, it is worth taking the pain to double-check such important information right from the start.

3. Proper Coding for Procedures, Modifiers, and Diagnosis

Maintaining correct coding practices is essential for ensuring the submission of better medical claims. What’s more, it is also essential to inform an insurance payer regarding what a patient is essentially receiving treatment for, in addition to the methods of treatment. It is vital to use correct diagnosis codes for elaborating on a patient’s treatment method. The use of accurate HCPCS and CPT codes is also important for providing additional information on the services rendered by a physician. These steps are incredibly important, as an insurance provider can only make a correct assessment if they have claims with correct modifiers and codes.

4. Managing Charge Entries for Submission of Better Claims

These correspond to the entry of charges for the services that a patient has received. The charge entries also make note of the suitable linking of the medical codes to procedures and services given to a patient on their visit.

5. Better Medical Claims Submission

Once claims are appropriately completed, they must be submitted to an insurance payor for reimbursement. Medical billers must have access to important information regarding insurance payors. It is owing to the fact that there are quite many variables for every insurance provider. This information can drive the process of submitting a claim.

6. Payment Posting

Payment posting is the last step which involves the posting and deposit functions. At this stage, the billed amount to a patient shall be zero if paid already in full, or it shall reflect an amount the patient owes. At this step, an insurance company’s responsibility must have been met. Adopting best practices for billing and claims submissions is vital to ensure seamless reimbursements.

Conclusion

Offering proper training to your staff and facilitating them with the proper resources is the first step towards achieving better medical claims submissions. Accurate claims submissions are crucial for improving the bottom line of your practice bottom line.

Frequently Asked Questions

What is a quality audit in medical billing?

A medical billing audit systematically evaluates the quality and compliance standards of a healthcare facility.

What are the 3 types of billing systems?

The three significant types of billing systems include:

Open Medical Billing System
Closed Medical Billing System
Isolated Medical Billing System

What is the most important part of billing?

The most essential and vital part of a medical billing process is ensuring the accuracy of the claims. Accuracy in billing operations is vital to ensure customers receive proper charges and receive credits for services and goods they receive. Accuracy in the billing process also ensures that all transactions within the system get recorded correctly.