Your medical billing process is the backbone of your medical practice – making money is the lifeblood that keeps your business going. However, it is not immune to complications in accuracy and efficiency.
It’s very common for a medical practice to experience challenges in medical billing, especially because the laws and standards seem to be constantly changing. It’s just one of the many difficulties faced by those in the health care industry.
Having an efficient revenue cycle, with the help of an efficient billing process, will help to increase your business’ revenue. It will also help your medical practice run more smoothly.
Medical Billing Issues
Here are four of the most common medical billing issues and tips for improving them:
1. Patient Unaware of Their Financial Responsibility
It is of utmost importance for your business to collect the full amount for medical services rendered. The number of self-pay patients is increasing, which can make it more difficult to collect full payments from patients.
Many patients also choose high-deductible insurance plans to keep their initial costs lower, but this means that the financial responsibility falls on their shoulders before insurance pays for anything. This increase in patient responsibility makes collections on services difficult, so you need to have a good and simplified payment policy in place in order to protect your revenue.
You need to clearly inform your patients about your payment policy and their financial responsibility. It’s ideal to collect any payments or co-payments there in the office before the patient sees the doctor, not afterward.
Simplifying your medical bills will also make it easier for patients to understand what they have to pay you and what was covered by insurance.
2. Incomplete or Inaccurate Patient Information
Inaccuracies in patient information or incomplete forms can lead to billing and collection denials — even the smallest details can lead to rejections. Make sure your front-end staff enters information on the following accurately:
- Patient’s name (ensure the correct spelling)
- Patient’s date of birth
- Patient’s gender
- Primary insurance (in the case of multiple insurances)
- Insurance payer’s name
- Relationship of the patient to the insured
- Policy number
- Group number if applicable
- Diagnosis code
- Procedure code
- Authorization code
It’s crucial to collect accurate information about the patient to lay the foundation for billing. Also, make sure the front-end staff verifies the patient’s health insurance status and coverage before providing services.
Denials due to inaccurate information can affect your revenue stream, since re-submitting the same forms involves a 30- to 45-day turnaround to finally collect payment. It also requires more time for your staff to spend on the additional paperwork.
3. Inaccurate Procedure Code
Coding claims inform the insurer of the patient’s illness or injury and what treatment was given. Inaccurate coding remains the top medical billing issue among medical practices.
Some common coding issues are:
- Errors in patient information
- Entering mismatched diagnostic codes and treatment codes
- Entering too many or too few digits
- Transposing digits
- Errors in modifiers
- Insufficient or incomplete documentation
- Entering outdated codes
Your front-end staff must be well-trained on current ICD-10 coding. Just as with inaccurate patient information, inaccurate coding re-submission involves a 30- to 45-day turnaround to finally collect payment.
4. Duplicate Billing, Wrongful Billing, and Upcoding
Billing for the same procedure, test, or treatment more than once is duplicate billing.
Misrepresenting a procedure for another procedure, for whatever reason, is called upcoding.
Wrongful billing is when you bill for services never rendered, or when a canceled procedure was billed.
These mistakes are mostly due to human error, but the practice may be penalized. The penalty is because some practices purposely try to bill for more money than they are actually owed.
Medical Billing Experts for Your Practice
If you are looking for ways to boost your revenue for your medical practice, look no further – you can outsource your medical billing services to ProMD. Our team can help you increase your revenues by 20 percent or more within 90 days.
We can take the burden of handling medical billing, pinpoint financial opportunities to drive up your revenue, and fast-track your billing processes.
Call us today at (844) 236-5488 for more information, or request a consultation online. We proudly serve medical practices in Florida, Virginia, Pennsylvania, and Maryland.