Resolve to Improve in These Key Practice Areas

December 11, 2018
By New England Accounts Receivable Management

It’s that time of year again. As 2018 is winding down, many of us are looking back over the preceding 12 months to reflect upon the ups and downs, the wisdom acquired and the lessons learned. If you run your own medical practice, such a review will likely lead you to identify what worked in your current approach and what didn’t, particularly when it comes to billing and claims reimbursements. The bottom line is that any approach that doesn’t ensure you can maximize revenue and profitability needs to be re-examined.

Every medical practice should resolve to address the three pillars of profitability—timely billing, accurate coding, and strategic handling of denied or rejected claims—immediately in the New Year. And rest assured, New England Accounts Receivable Management can assist you in improving your approach to each one of these vital practice areas.

Is Your Billing Accurate and Timely

Ongoing changes to the U.S. healthcare system continue to bring about a variety of challenges for medical service providers. Many aspects of healthcare reform, like the introduction of more time-consuming, value-based compensation models, and the frequent alterations of billing rules and regulations, can result in revenue losses for providers.

Failure to stay up-to-date on medical billing rules and regulations, in addition to billing errors, results in U.S. medical providers leaving approximately $125 billion in uncollected revenue each year. And some specialists face even greater challenges due to the complexity of the procedures they perform and the associated billing requirements.

Changes in billing requirements can seem head-spinning, but there is hope for healthcare providers. To mitigate practice financial issues and compliance risks, we encourage medical practices to take a more proactive approach to their billing procedures. By preventing problems before they happen, healthcare practices can maximize their revenue, ensuring they’re properly reimbursed, and that they are then able to focus their attention on delivering there much-needed services to their patient population.

For three decades we’ve been assisting medical practices in establishing more effective and efficient billing processes. And while we customize our approach based on the particular needs of your practice, there are several measures your healthcare practice can taketo be more proactive in your medical billing procedure:

Establish a Clear Collections Process

All providers need a consistent collections process to ensure the financial health of their practice. Establishing a step-by-step approach clarifies the procedures for all involved, and can greatly improve revenue cycles by ensuring patients are properly and thoroughly informed of their responsibilities.

All collections processes should involve a few key steps:

  • Establish clear terms
  • Collect necessary patient information
  • Verify all contact information
  • Make sure patients are clear about co-pay responsibilities
  • Verify insurance eligibility in a timely and regular basis
  • Collect up front for co-pays
  • Make payment options clear
  • Establish a regular sequence of communication

Though establishing such a process can seem detailed and time-consuming, implementing a standard collections process can help healthcare providers collect reimbursement more quickly, better identify when to send a bill to collections, and eliminate lack of communication or knowledge as a reason for patient delinquency. Let us know how we can help!

Minimize Coding Errors

Proper and correct coding can mean the difference between having a claim accepted or rejected, paid or denied.

While coding is generally a standard method of describing procedures, costly errors can still occur. The most common errors, such as incorrect, mismatched, or missing codes, are easier to catch before they become an issue. However, some common errors are more difficult to catch. These errors include:

  • Non-specific diagnosis codes
  • Incorrect modifiers

The items listed above are the most frequent sources of coding errors however, other potentially problematic errors do occur as well. These include Upcoding and Undercoding, which can often be sources of error.

At NEARM, we are rigorous and extremely well-versed when it comes to spotting and correcting possible issues with incorrect coding. Our clients enjoy peace-of-mind knowing they can leave such detail-oriented work to experienced professionals.

Handling Denied or Rejected Claims

Do you know the difference between a rejected claim and a denied claim?

A rejected claim is one that hasn’t been processed yet due to the discovery of one or more errors. It’s preventing the insurance company from paying the bill as it’s written.

A denied claim, on the other hand, is a claim that the insurance company has processed and has deemed unpayable due to a discovered violation of the payer-patient contract or some vital error caught after processing.

In both of these cases, the payer will return the claim to the biller with an explanation of the problem. A rejected claim can be corrected and resubmitted, but a denied claim must be appealed before resubmission, a much more costly and time-consuming process. Knowing how to effectively appeal a denied claim can mean the difference between receiving reimbursement or not.

Having managed this process for scores of clients over our 30 year history, we know all the ins and outs of the claim appeal process. We always welcome the opportunity to put our expertise to use in order to benefit our clients.