One major challenge of medical practice management is balancing excellent patient care with the necessity to run an efficient business. Last month we talked about how benchmarking can give you an overall picture of your practice’s financial health while establishing financial goals to strive for. Another important process that should be performed yearly (at a minimum) is a thorough billing assessment.
Put simply, billing assessment involves examining your practice’s revenue cycle from top to bottom. The revenue cycle begins when a new patient’s insurance is verified and ends when the patient’s account reaches a zero balance. A proper billing assessment will consider every step in between. A good way to approach is to look at the process from end to beginning. Working backwards will identify problems in the cycle, and continuing backwards from there will likely reveal the source. These could take the form of improper coding, mistakes in claim preparation, failure to follow necessity guidelines or a number of other issues in the medical insurance billing process.
The place to start your billing assessment is with a series of self-audits. Audits should be routine anyway as they will point to revenue draining issues like under-coding and over-coding, incomplete documentation, payer denial trends, underperforming accounts and services, and where other medical insurance billing errors are being made. Data from the audits should be compared to industry benchmarks to measure your practice’s performance against top performing practices. All of this will lead to effective emulation of those top performers’ best practices.
There are many other areas that a billing assessment should cover. Examine the format and methodology of all current forms like patient intake, claims, final reports, etc. Make certain that all forms used by your staff and patients are clear, succinct and free of extraneous, time wasting items. Review the performance of your Electronic Medical Record system. It should be regularly updated with current diagnosis and billing coding. Furthermore, ensure that all involved staff is up to date on CPT and ICD-9 coding. The billing assessment should also include reviews of fee schedules, necessity guideline compliance and payer audit risk analysis.
Speaking of payer audits, if your practice has experienced one, you should be on the lookout for claims and documentation audit review flags that payers use to identify cases that are suspect. A systematic review of payer coverage guidelines, contract negotiations and payment policies will help with this matter.
This list is of course, not exhaustive. Medical practice revenue cycles tend to be complex and multi-faceted. Before beginning your billing assessment, you must decide if you have the necessary man power to dedicate to it. ProMD Practice Management has years of experience in providing complete medical practice billing assessments. Our professional auditors can provide the objective review of your billing cycle necessary to identify problems. Furthermore, our billing assessment services include a complete report of findings and a comprehensive set of guidelines to correct problem areas. Take it a step further with staff training and insure that everyone is on the same page going forward. ProMD can help you get your billing cycle running at maximum efficiency.
ProMD Practice Management is happy to help with your billing assessment needs so you can maximize profits and increase patient satisfaction. To learn more about how ProMD can make your practice run like a well-oiled machine, call 888-622-7498 or fill out our online form to request a billing assessment.