Health care providers confront challenges claiming revenue with health insurance companies. Considering majority of revenue generation with health insurance, they concentrate on receiving payment without any hassle. Being occupied with patients and providing health care, claiming their bills with insurance not only becomes a hurdle task but also last priority in their tasks list.
Now, medical billing comes into picture. They make doctor’s task easy and promise claims for better revenue to hospitals. Health care provider realize benefits by assigning their revenue claims to have a smooth-flow of revenue generation in RCM.
What is medical billing ?
The procedure of submitting and attaining claims from health insurance corporation in order to obtain revenue for services provided by health care is called Medical Billing.
It converts health care service into a claim and works for payment receipt with health insurance.
Claims remain difficult without medical billing.
Medical billing team takes responsibility to scrutinize if the charges and services mentioned are accurate.
Errors in this process might lead to no response or denials with the health insurance.
Health care providers might go on a blink without the assistance of the medical billing companies as it’s difficult to support medical service and claims at once.
Medical billing bestows these claims with a seamless flow of revenue for service delivered by the doctors.
There are regulations involved in medical billing process. The billing team must be conscious while claiming, which otherwise would become a hard task to deal with the insurance corporation.
An accurate billing can expedite the procedure, decrease complications and take to faster claims and revenue gain.
In case of denial or no response, the billing team takes control in the process of receiving the revenue for our clients.
Now let us take a look at the 7 key things to know about Medical Billing in Revenue Cycle Management.
Role of Medical Billing in RCM :
It plays a crucial role in generating revenue to the health care provider by extending their services back and forth.
Medical billing delivers a smoother and swifter service to the health care providers by means of Revenue Cycle Management.
It concentrates on smaller and larger health care hospitals with cost-effective and facile claim reimbursement services.
In RCM, medical billing companies inspects on patient insurance details and aid easy claims from the insurance corporation.
They are associated with certain norms which the billing team has to diversify it’s proficiency in providing revenue growth.
Quicker post payments are always possible with accurate medical billing.
Follow-up at regular intervals brings continuity in the performance and successful revenue claims.
Efficient in handling denials and no response by noticing the reason and moving claims forward for a post payment is an important job..
Process of Medical Billing:
The process of medical billing includes,
- Patient registration
- Insurance verification
- Medical transcription
- Medical coding
- Charge entry
- Billing and claim transmission
- AR calling
- Denial management
- Payment posting.
A detailed article on the 10 steps of medical billing process can be accessed here
Essential factors in Medical Billing:
For a timely revenue claim, Medical Billing acquires crucial aspects such as claim validation, advanced software technology, codes and compliance.
Claim validation has to be performed quickly for the advanced medical billing practices. It fixes any errors that occur during a claim. It also displays a reminder to make corrections if required before claiming the revenue with the insurance.
Software technology pays attention on the server capacity and upgrades in the system. It allows to make the claims with no difficulty in any circumstances. It concentrates on the data center operations and backup to safeguard patient’s information.
Medical billing depends on accurate and flawless medical codes. The codes hold complete health record of the patient. Medical transcription leads to medical coding for a quick process in revenue claims.
What makes medical billing successful?
Being clear and concise on the terms and conditions of the bill extends a fair billing documentation with stable explanations. It is an advantage for the medical billing process.
Paying attention on the patient’s bill while claiming can avoid rejection of the bill. If the bill is rejected, it’s less likely to be successful in accepting revenue from the insurance.
It’s essential for a medical billing team to be aware of the concept as well as terms and conditions involved.
Collecting the data of the patient gives an opportunity to improve billing practices. It leads to accurate billing format practices to dodge errors.
It’s important to claim the bill soon after providing health care. Later the claim after the treatment, lesser the chances of payment posting.
Data verification stands as a base, so taking appropriate information is vital.
Benefits of medical billing:
It endeavors maximum productivity to the health care provider by taking the responsibility to address the entire billing process.
Health care provider can focus on their administration and better patient care and staff training.
Opportunity enhances patient engagement rate dramatically as medical billing offers customer service support and portals. Patients are encouraged to use online portals for the appointments and further procedures. As a result revenue growth is achieved.
Extends a cost effective support and work-space to deal with high volume of patients.
Reduces burden, deals with insurance conflicts and claiming issues and helps to focus on patient care.
Chances for Denials in Medical Billing:
Coding is not definite enough. Each diagnosis must be coded to the highest level. If not, they will face denials.
Claim information gone missing. When the patient’s required or common information is missing, it is a cause for denials. Be cautious while submitting the data of the patient and scrutinize claims for required documentation.
Not filing claims on time. When a claim is not filed on time, it crosses Timely Filing Limit for an insurance. Each insurance has own time limits to file a claim.
Error in patient’s identifier information. If the identifications including name, sex, diagnosis and policy numbers are entered incorrectly, the insurance company rejects the claim.
Problems in coding. Medical biller needs to upgrade his/her coding knowledge accordingly. If he/she enters a wrong code or an expired code, claims could be denied.
Strategies of Medical Billing:
Set up a crystal clear collection process. The patient should be informed about his health care expenses clearly in advance. Explaining the payment responsibilities steadily, patient will be aware of his expenses and it helps in revenue growth.
Flawless claims submission. Most of the denials occurs due to false coding or the errors in coding. Efficient billing system is capable of recovering such issues.
Denial management. Few precautions can protect the medical billing from denials. Most of the denials include false information, wrong coding and not being punctual during claims. Efficient denial management can help the billing from rejections.
Keep updated. Medical rules and codes change regularly so upgrading eventually is an add on to the service. It can avoid re-submissions dealt repeatedly.
Insurance verification. Checking foremost details of the patients and an accurate entry makes it less complicated. Medical billing companies can’t rely on the false information which gradually pulls down their market. Thorough upgrades and concentration on patient’s report guides the company successfully.
Following certain guidelines, the process of medical billing in Revenue Cycle Management participates with highly qualified assistance for a better growth in revenue.
3 important things to know about Medical Billing:
- Claims Validation
- Cloud Computing
- Codes & Compliance
- Claims validation is the most prominent aspect and doing it as quickly as possible is very essential for the healthcare professionals’ practice.
- It alerts and enables to recorrect in the places necessary and smoothens the process without any complications.
- Cloud computing services helps to maintain proper data center operations and provides an aid to store the data and safeguard them in preferred locations.
- It helps to restore the data or information whenever required without any delay.
Codes & Compliance:
- Medical billing process relies on accurate medical coding to the larger extent.
- Safeguarding the private information of the patients is also a hazardous task. If the government makes changes in the privacy regulations, the technology used by the billing team should automatically safeguard the data.
- Feasible payment process depends on the latest software and cloud computing services.