The Dos and Don’ts of Medical Billing

December 17, 2019

In the old days, you would see a doctor and would receive a bill of service on the spot. Perhaps you would pay quid pro quo: a quart of soup in payment for treating an ear infection; a brake job in return for setting a broken leg. Otherwise, you would receive a bill, then pay it.

Times have changed, and with it has come a level of sophistication unforeseen even by practices that have been in existence for quite some time. Sure, insurance complicates things. So one would think that not taking insurance at all would be easier for an office to manage their medical billing, right?

Not so much. Whether a practice takes insurance or not, there are still many dos and don’ts (legally, ethically, and financially) when it comes to medical billing.

And when you consider that a key factor of being able to continue providing patients the care and service they deserve is to maintain a strong bottom line, knowing the dos and don’ts of medical billing is essential.

Best Practices of Medical Billing

For medical practices to stay financially stable and strong, here are some of those dos and don’ts of medical billing:

DO Conduct a Medical Billing Assessment

The medical billing landscape and rules are constantly changing. Billing assessments allow your practice to ensure that your billing processes and systems are current and appropriate.

Assessing your current billing system can help identify areas that need attention, and can give you the guidance you need to make your current system even more efficient and cost-effective.

DON’T Ignore Medical Billing Standards

Whether you have an internal billing department or you use an outside company, be sure to use the key performance indicators by the Medical Group Management Association (MGMA) to monitor internal performance. Doing so will help ensure that the right outcomes are achieved, with no room for error or denials.

DON’T Forget Emergency Appointments

You do everything in your power to take emergency appointments if the emergency is non-life-threatening or doesn’t merit a 911 call. But does your practice include proper emergency coding when billing?

Because emergency appointments can disrupt your daily flow, these services – while necessary – are additional to the basic services you provide, and you should be compensated appropriately.

DO Submit Your Claims On Time

Some insurance companies accept only paper claims; others only electronic. Be sure to know the deadlines for filing for each company whose claims you accept.

Account for processing times, weekends, and holidays. Also consider possible denials, incomplete forms, and the time the claim is in the mail.

DON’T Forget Proper Documentation

Certain procedures and services require you to provide additional documentation. For example, Modifier 25 claims, which are used to bill for same-day evaluations and procedures, often are not successful because they lack proper documentation.

Before you hit “Submit” or drop that claim in the mailbox, be sure you have included everything to support that claim.

DO Provide Detailed Documentation for Out-of-Network Patients

If you don’t take insurance, are out-of-network, or ask the patient to file their own claims, be sure to provide the patient everything needed to file the most efficient, cost-effective claim. As an example, many radiologists and anesthesiologists are out-of-network – and when the patient or policyholder receives the bill, they are in sticker shock.

First, doctors should tell the patients beforehand if any additional doctors on their team are out-of-network. Second, those doctors should code their bills thoughtfully to ensure that there are no unnecessary fees attached to the bill.

DON’T Try to Do Everything

Many medical practices are hiring skilled medical billing and collections companies to alleviate the extra burden on their practices – so they can focus on health care rather than finances. Outsourcing your medical billing services should increase your revenue by about 10 to 15 percent, and an experienced company may be able to increase revenues even more than that.

For example, with ProMD, you can expect to increase your revenues by 20 percent or more within 90 days. Some of the costs eliminated by doing this include the cost of hiring or training coders, working with an IT company, working front-end and back-end collections, maintaining proper documentation, and record-keeping.

Hiring these services can save your practice time and money, reduce liability with regard to HIPAA laws, build your bottom line, and – most importantly – allow you more time to build relationships with your patients.

Medical Practice Billing Company

If your practice is considering outsourcing its billing and collection, or if you are dissatisfied with the company you are currently using, consider the certified billing and collections experts at ProMD Practice Management. ProMD takes the burden out of handling billing functions, and we can also pinpoint financial opportunities to drive practice revenue.

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.

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