Billing Optimization, well we are getting paid isn’t that the goal of our practice? So many times I have heard this question. And the answer more often is, no.
While a medical office may indeed be receiving an acceptable turn around in patient account payments, more often than not they are not experiencing a dynamic increase in revenue. So maybe it is time to take a new look at how you are approaching your medical practices revenue strategy. The key is knowing what it truly means to be billing optimized and how to view it.
Is there any industry in which individuals are expected to leave after a service not knowing what their payment will be? Only Medical Billing.
Imagine a medical billing and coding process where all patients are billed accurately, payment information is easily accessible and payment arrangements can be made on the spot before the patient ever walks out the door. Billing statements are a task of the past. Turnaround time for payments are decreased significantly with 90% of insurance claims receiving payment within 60 days. For many medical practices still struggling with keeping patient accounts up-to-date, increasing revenues seems like a secondary thought.
Getting the Payment Combination Right
With any billing procedures, there are always a combination of details that must be made to accomplish payment being received. With Billing Optimization these details tend to be marked in two primary areas, patient/treatment coding and doctor credentialing.
Attaining the Correct Code Combination
Just like on a treasure map the rules can be very complex when it comes to finding the perfect combination that will correctly reflect the diagnosis of the patient (ICD-10 Codes), provide information on any medical devices needed for the treatment (Medical Product Codes) and last, meet all insurance claim’s and billing guidelines (CPT Codes) for payment. Without the proper combination of these codes, patient bills can be stuck in a spiral of kicked-back insurance claims and patient account disputes.
Physician Credentialing can often be a stumbling block for practices, especially with large practices where seeing patients is shared across a large team. While doctor is licensed and board certified to practice medicine, they may not be credentialed with all insurance carriers for all areas of patient treatment.
Imagine this common scenario. Doctor B is credentialed to perform services for Insurance Company A. Doctor B is out sick and Doctor A (who has not been credentialed with the insurance company yet as he is new to the practice) sees a patient (covered by Company A) and provides a service. So when the patient’s bill – insurance claim comes to the company it is denied and kicked back to the medical office. Now bills are created and the patient phone calls start. The result is the patient is dissatisfied and the payment has not been received (and may continue to be delayed for 90-120 days); staff research time and revenue turnaround time have been sacrificed. And this is for a bill that would normally be a quick, insurance receivable payment.
A Chart Analysis (Billing Audit)
One of the best tools for gauging a medical practice’s billing optimization is a Chart Analysis (Billing Audit). With a chart analysis (a free service with Medical Consultants Group) a medical practice can receive a snapshot of their most commonly used diagnosis codes, patient treatment therapies and billing needs. From this survey process (pulling a sampling of patient charts) a medical practice is given the solutions to increase revenue and decrease billing expenses.
While your medical practice’s billing may seem to be getting by, it is important to always keep your eyes open for potential Increased Revenues. Having your Billing Optimized will encourage the development of a revenue increase strategy that can benefit both the staff and medical practice as a whole.Billing optimally requires just a small team. Often billing expenses can be decreased through outsourcing of the process. Whereas current expenses may include: hourly pay ($14+), benefits (insurance, vacation pay, etc.) and a dedicated office space for the team member, outsourcing does not. In fact, in most instances, the outsourcing fees are around the 6% rate and are not required unless the payment is collected.
If you are interested in a FREE chart analysis (and billing audit) or finding out more on how your medical practice can become fully optimized, contact Medical Consultants Group call our office directly at (404) 272-4883.