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Billing Accuracy in Healthcare

The healthcare industry is booming, and its compressive growth is expected to continue. Over 46 million Americans fall in the age bracket of 65 or older, expected to double by 2026. More than 68 percent of old-age Americans suffer from two chronic illnesses; thus, the resources and the importance of billing accuracy in healthcare will not be subsidized anytime soon.

From a bird’s eye, doctors and nurses seem to be running the show at most healthcare facilities. At the same time, that is a fair observation, as they are the people treating patients. However, at a broader glance, one finds that many other individuals work inside healthcare setups, performing tasks that make doctor visits possible. Two such responsibilities are medical billing services and medical coding. 

Understanding Billing Accuracy in Healthcare - What is Medical Billing?

Medical billing services are a vital process in the perceptual functioning of a healthcare practice. Healthcare billing involves the preparation of billing claims and submission of these claims to insurance companies. This process ensures that a medical practice is reimbursed on time with the correct amount.

Healthcare practices receive money from private insurance entities and other healthcare programs under the government’s jurisdiction, including Medicaid and Medicare. Receiving timely and proper funds ensures that medical offices stay open, as proper payments are necessary to offer good healthcare services to patients.

Significance of Medical Billing and Coding

Coding and medical billing services are imperative for the upkeep of medical offices, clinics and hospitals. Medical facilities rely on insurance providers for funding, while insurance providers profit by charging people who hold their monthly policy fees or premiums. The individual buy-ins of the pool let insurance providers cover the bulk of policyholders’ medical costs. Considering this, much money comes from reimbursements rather than directly out of the consumer’s pockets. Thus, it is important to describe the importance of coding medical charges accurately. Below are the top three important things to remember for greater accuracy and compliance.

Financial Stability and Protection of Your Healthcare Practice

Erroneous billing in healthcare and inaccurate coding can have serious financial consequences for your business. More often than not, such cases shall result in your practice not getting the full amount you are due to receive from patients or insurance providers. Even more concerning is that noncompliant and inaccurate coding can make your practice susceptible to lawsuits. In order to ensure billing accuracy a biller coder should work to ensure that a practice is achieving compliance and is well protected financially.
Moreover, inaccuracies in billing and coding can result in delays or denials of claims and payments. If your medical practice doesn’t have an effective denial management protocol or strategy, such claims can be written off entirely or resubmitted erroneously.

Patient Protection

For accurate medical coding, it is important to pinpoint and even document precise diagnoses and treatments performed for a patient at your practice. The said documentation shall remain a part of the patient’s medical record, so to protect your patients, it is important to keep this documentation accurate. Starting from lab tests to x-rays and prescribed medications, patients or their designated families may need access to this crucial information at any given time. Erroneous information can even harm a patient and the accuracy and quality of their future care. Consequently, it is highly improper to put patient health at risk because of something preventable like inaccurate coding/billing.

Projecting the Future

When a medical practice’s operations comply with medical coding protocols, it gets much easier to ensure billing accuracy in healthcare for insurance providers and patients. Accurate billing and coding practices enable you to forecast for the future. With accurate coding and billing, your practice can effortlessly analyze accurate data on revenue, write-offs, costs, et al. This alone allows your practice to make informed and targeted decisions for better financial success in the future. Accurate billing helps make crucial business decisions involving patient outreach, staffing, and adding service lines to your private practice.

Final Word - Achieving Stronger Compliance Accuracy for Your Practice

In order to ensure billing accuracy a biller/coder should probably wonder how to improve a practice’s current system. If a practice needs help to ensure compliance and fears missing out on capturing the max reimbursements, it is best to go for a third-party medical billing and RCM services provider. Effective RCM strategies boost the accuracy, efficiency, and reimbursements for medical practices. A third-party company can take the burden off of you and your staff. It is imperative to note that billing accuracy in healthcare improves practice compliance and efficiency, letting your team focus on providing the best medical care to patients.
On the other hand, if your practice already has a billing team, proper systematic coding education might be the next action for boosting billing accuracy in your healthcare practice.

Frequently Asked Questions

Billing accuracy in healthcare is the key to maximizing revenue. Correct and accurate billing ensures that healthcare providers receive timely and full payments for their services.

Accurate medical coding ensures precise documentation of diagnoses and treatments, safeguarding patients’ health by reducing and preventing errors in their medical records.

Accurate coding enables healthcare practices to analyze revenue, costs, and write-offs. This allows them to make informed decisions for better financial success and plan for the future.