Timely, accurate, and full reimbursement is the most critical metric for keeping the lights on at your practice. But only around 80 percent of claims submitted are processed and paid on the first submission – leaving a whopping 20 percent unprocessed, returned unpaid, or requiring additional energy and time from your staff for resubmission.
Are you doing enough to make sure you’re always paid what you deserve? Here are a few quick and easy medical billing tips to get your practice paid in full more efficiently.
5 Medical Billing Tips for Your Healthcare Practice
1. File Claims Daily
Getting payers to reimburse you in full is challenging enough. Don’t let timely filing ever be a reason for a denied health insurance claim! If your staff only dedicates one to three days of the week to filing claims, they can pile up much more quickly than you realize. Never let a stack of charges turn into a payment issue. Make it a priority for your back-office always to file daily to improve your clean claims ratio.
2. Collect Co-Pays at Time of Service
As a billing company with 40 years of experience, we’ve said it before – any unpaid balances hurt your revenue. Those $15 or $30 patient co-pays may not be top of mind when you think about your reimbursements, but they’re just as critical to your balance sheet as any other payments owed.
Determine in advance what co-pay each patient owes you at the time of service and make it an office policy to collect in advance. Have your front desk staff escalate any issues with patients who regularly refuse to pay up.
3. Update & Verify Patient Insurance
We understand that patients (especially frequent visitors to your office) hate to dig up and hand over their insurance cards every time they come in. But making sure that there are no changes to a patient’s insurance is the only way to make sure that you handle things appropriately with their insurer.
While conducting eligibility checks may be becoming passé in some specialties, we’re firm believers in verifying each patient’s coverage in advance of the encounter. It only takes a few minutes to verify insurance, but unpaid claims down the road could take you months to collect.
4. Track & Follow-Up on Unpaid Claims
Are you keeping track of submitted claims and tracking how long it takes for them to be paid? You can’t just sit back and expect timely, accurate payments to come into your office regularly. Knowing what you’re not being paid for is just as important as knowing what you’re being paid.
If a claim takes longer than sixty days to be paid, follow up before you resubmit. Sometimes all it takes to get your claim handled by a payer is a phone call.
5. Make Friends with EOBs
Scrutinizing all explanation of benefits (EOB) forms can be a smart way to spot unnecessary payer downcoding, bundling, or denials. Assign a staff member to compare EOBs to payments, and don’t let any of the forms slip through the cracks.
You may also want to consider working with a medical billing company that has the bandwidth to pay close attention to EOBs and the expertise to follow up appropriately with the payer. Getting paid correctly may require persistent follow-ups; outsourcing to a medical billing service can take the time and effort of that task off your office’s hands.
Medical Billing Tips for Dealing with Underpayments
Practices tend to consider their contracts with payers to be a binding commitment, but are they? Unfortunately, insurance companies routinely pay about 10-14% less than their contracted rates to practices. If you’re not paying close attention to payer payments, your practice could be getting gouged. Eliminating underpayments is critical, but requires education, data, and a proactive approach.
Here are some quick medical billing tips and steps for addressing underpayments at your practice.
Step 1: Know What You’re Owed
Sorting through and reviewing your payer contracts can be tedious and time-consuming, but it’s essential. You need to know what your payers should be paying you before you can go out and get it. Gather your agreements and list out each payer’s contracted rates by CPT code in a spreadsheet. (Use this opportunity to compare payer rates against each other. Not only is the information useful for the next step of determining low payments, it’s crucial intel that will come in handy when you renegotiate your fee schedules down the road.)
Step 2: Compile Your Data
Armed with your contract information, compile statements and reimbursement data from each payer for a given amount of time – one to three months – into another spreadsheet, compare actual payment data to the rates in your first spreadsheet at the end of the period. (If you use advanced medical billing guidelines and software or work with a medical billing service, this process will be less time-consuming.)
Are payers coming up short? Is it happening rarely or sporadically, or is there a strong tendency to underpay? What’s the average percentage of each underpayment, code by code? Collect all of this information in a clear way, or summarize it into a written report explaining the scope of the issue.
Step 3: Approach Your Payer
The most important step is to speak up and be heard. Make a game-plan beforehand; having your chief biller contact a low-level rep at the insurance company likely won’t result in any productive action.
Review your contracts very carefully, then have a physician or practice manager request a meeting with the person at the payer responsible for negotiating the original contract. Come to the table armed with data and a predetermined request (i.e do you expect back payment? or simply want accurate payments in the future?).
If the payer is nonresponsive or you fail to reach an acceptable resolution to the problem, consider legal action (being mindful, of course, about what your contracts say about filing court actions).
Step 4: Stay Aware
Ideally, your practice manager walks away from the meeting with the payer with a positive outcome and a commitment from them for higher, more accurate reimbursements. If that happens, don’t let the resolution be a temporary fix. A payer could easily pay the contracted rates for a few months then fall back into underpayment territory. Pay attention!
Audit payments from all your payers every several months to make sure they’re paying as promised and regularly monitor key performance indicators to spot unhealthy payment trends. If the problem persists, work with a medical billing company; they often have stronger, more enforced relationships with payers to help you get paid.
4 MORE Medical Billing Tips
1. Get Your Credentialing and Licensure in Order
All insurance billing is predicated on physicians being credentialed, but the process has become increasingly difficult due to payer and state-specific requirements. Whether you are a solo provider managing your new practice or you are a multi-provider practice adding a provider to an existing facility, you need to start the credentialing process early. Target 150 days before the provider plans to start seeing patients to begin credentialing.
Obtaining a medical license, either initial licensure or a second or subsequent license in another state, can be challenging. To help physicians navigate the licensure process and to provide up to date information on licensure requirements across all US states and jurisdictions the Federation of State Medical Boards (FSMB) maintains a state-by-state list of requirements.
2. Use CAQH to Simplify Payer Enrollment
Working with payers is not always easy, but thanks to an initiative from the Council for Affordable Quality Healthcare (CAQH), provider enrollment with payers is a little simpler than it used to be – giving you less reason to reach for the ibuprofen.
CAQH, a non-profit alliance, has several different initiatives focused on streamlining the business of healthcare. CAQH strives to be “a catalyst for industry collaboration on initiatives that simplify healthcare administration for health plans and providers” in pursuit of higher quality care for patients.
One of CAQH’s programs is ProView, an all-in-one platform where providers can submit, store, update, and access the information they need to work with payers. Credentialing, claims processing, and quality assurance are all included in ProView, with credentialing being the primary service. Payers working with CAQH can use ProView to electronically download participating providers’ information into their systems.
CAQH also offers EnrollHub, a secure electronic funds transfer (EFT) and electronic remittance advice (ERA) enrollment tool. EnrollHub serves as a single online enrollment hub for working with your health plans – eliminating the need for you to enroll in EFT and ERA separately with each payer or to process your claim payments by paper check.
Plus, CAQH asks for minimal information from your practice during the registration process and handles sending your enrollment information to the payers you select. Best of all, it sends payer payments directly into your bank account. Combining CAQH with an efficient medical billing service can do even more to streamline processes at your practice.
3. Implement Time-Based Coding for E&M Services
Sometimes a visit goes long – an extra five or ten minutes – and it throws off your morning schedule. A visit often goes way too long – an additional 20, 40, or even 60 minutes – and it practically wrecks your entire day’s schedule.
The upcoming 2021 update to Evaluation & Management coding (E&M coding) allows practices to account for this situation by billing based on the total time spent on an encounter with a patient, including both face-to-face and non-face-to-face time. When used for E&M billing, time is also used to determine the appropriate code level for indicating the complexity of medical decision making.
Time spent on the following activities can be billed as E&M services provided they are accompanied by the appropriate documentation:
- Reviewing tests in preparation of a patient visit.
- Obtaining and/or reviewing separately obtained history.
- Performing a medically necessary appropriate examination or evaluation.
- Counseling and educating the patient, family, or caregiver.
- Ordering medications, tests, or procedures.
4. Split Names into Columns in Excel
This may seem like a minor medical billing tip, but it’s quite important when you’re working with large databases of patient lists. In those lists, it is very common for the patient’s first, middle, and last names to be combined into one single column. This makes it impossible to sort or filter the data based on the patient’s last name.
Splitting the single name column into multiple columns for first, middle, and last names makes it much easier to organize and manage the patient list. Fortunately, this is quite easy to do even if you’ve already entered names into a single column.
Enhance Your Billing and Coding with NCG Medical
As an experienced medical billing company, NCG Medical has the knowledge and resources your practice needs to boost its clean claims ratio and keep insurance reimbursements flowing smoothly. Whether it’s keeping up with the latest CPT coding changes or adapting to the latest EHR technology, we’re always trying to find ways to protect and improve revenue cycle management for our clients. To find a few more efficient medical billing tips and learn what we could be doing for your practice, contact the NCG Medical team today for a consultation.