How Your Practice Can Receive Maximum Compensation for Medical Billing

July 19, 2019 by Antonio Arias, MBA, CHBME

Topics: Medical Billing, Revenue Cycle Management

When it comes to managing medical billing, there’s a lot that can get left on the table. Between rejected claims, failure to resubmit claims and other similar billing issues, your medical practice could be missing out on a lot of money.

Here are a few proactive steps to take to ensure your practice is set up to receive the most compensation possible for medical billing.


1. Set Up a Clear and Efficient Collections Process

Having a consistent, easy-to-follow collections process can help ensure your practice’s revenue cycles, finances and overall customer experiences are in good health. Here are a few ways to be proactive in establishing your process:

  • Give patients a clear understanding of their debts and what’s expected of them. Having trouble with unpaid balances? Here are some effective tactics to help you collect more quickly. 
  • Make sure to request highly valuable patient information, including their name, date of birth, home address, cell number, email and name of workplace. It’s also important to get a copy of their photo ID in case a bill has to be sent to collections at a later time.
  • Frequently verify that patient information remains accurate. This is especially important for address changes, name changes and other major updates.
  • Regularly verify their eligibility at every visit. This will help minimize claim denials and prevent lost or delayed payments.
  • Collect co-pays from patients up front and be clear on what forms of payment are accepted, including any payment plans that may be available.
  • Notify patients when payment is about to be due, is currently late and ready to be sent to collections. Sometimes letters can be more effective than phone calls or emails.

2. Double Check Claims Before Submitting


By now, you have likely experienced the frustration of resubmitting claims after being denied the first time. In fact, your practice has probably played some part in the 80% of all medical bills that contain errors. Here are a few things to double check to ensure you don’t have to deal with a claim once it’s been submitted:

  • Patient, Provider and Insurance Information: confirm that things like patient name, date of birth, insurance ID/policy numbers, and any other relevant information is correctly documented.
  • Already-Reported Services: It’s important to confirm that services are not reported or reimbursed twice, as duplicate billing will complicate processing.
  • Unclear Denied-Claim Information: If a claim is denied, a claim number and denial code should be provided to explain the error. If this information is not included or unclear, it can cause complications with identifying the error, thus prolonging their approval.

If you do end up receiving a denied claim anyway, be sure to address it quickly so as to reduce the time spent on appealing and resubmitting the claim, as well as prevent them from piling up on your team.


3. Verify Your Medical Coding Is Correct

Another way to help ensure your practice is getting the maximum reimbursement possible is to reduce your coding errors. Though many coding errors are usually detected by clearinghouses early on, there are others than can be difficult to catch. Here are some coding items to pay attention to:

  • Diagnosis Codes: When documenting a diagnosis, a lot more detail about patients’ conditions are needed to meet ICD-10 requirements—detail that may have never been collected in the past. Addressing insufficient diagnosis codes can usually be fixed by gathering more of the missing initial data needed from the referring physician.
  • Modifiers: Reimbursements are commonly lost due to incorrect modifiers, whether they are incorrect or missing from claims.  
  • Upcoding: Upcoding involves using codes that are reserved for more expensive procedures instead of the ones that should be used for the service rendered. It may happen by accident, but if it’s done on purpose, it is illegal. Here’s how to know if you’re upcoding at your practice.
  • Undercoding: Leaving out or inputting less-expensive codes for services rendered is called undercoding, which can also happen accidentally or intentionally.


4. Rely on Medical Billing Experts When You Need To


Between managing patients and staff and staying up to date with industry trends, new coding standards and medical billing regulations, there’s a lot on your practice’s plate on a day-to-day basis. Many providers try to do it all, and unfortunately, many end up falling behind—a costly mistake that can easily be prevented.

That’s where medical billing outsourcing comes into play. With a professional and experienced team of certified coders, MBAs and CPAs, you can rest assured you’ll have a team of experts working toward the best financial health your practice can be in.

At NCG Medical, we offer medical billing for practices in primary care, dermatology, gastroenterology, radiation oncology and holistic services. View our recent case studies to see how we’ve helped practices just like yours get you the maximum compensation your practice deserves.


For more ways to help your medical practice thrive, contact NCG Medical now or view our blog today!





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