Is it Time to Update Your Medical Billing Policies?
Like many other areas of your practice, your medical billing is likely a matter of routine. If your staff members know how to do their jobs well, your billing department may run like a well-oiled machine. But is that machine operating at optimal efficiency?
To assess the effectiveness of your medical billing process and practice management, it’s important to put your policies down on paper and review and update them periodically. In our experience, small practices often don’t do this, relying instead on legacy staff to educate newcomers on how their software works, what their steps are, and who is responsible for certain billing-related tasks.
If your your practice operates this way and the entire end-to-end process is housed only in the heads of your billers, you could be headed for trouble if they leave or retire. (Even worse, relying heavily on your team in the absence of written policies can put you at risk for embezzlement.)
If You Don’t Have a Policy Guide…
…then it’s time to create one from scratch. Task a member of your team with “auditing” your billing department to sketch out the entire billing process. Or better yet, hire an outside consultant who can help you not only outline your current process, but assess and improve it.
Have the point person interview individual billers about their roles and responsibilities, and subject them to biller training so they’re fully immersed in the intricacies of modern billing processes. Armed with that information, have them create a step-by-step list detailing how a claim moves through your office from start to finish, beginning when a patient calls to make an appointment and ending with payment to your practice.
Include in your guide pertinent information about the major payers you work with, the most common services rendered at your practice and the associated costs, details about how your software works, and “troubleshooting” info about any issues you frequently face: tech bugs, typical denials, or any other kinks in your system.
If You Do Have a Policy Guide…
…then consider how long it’s been since you’ve reviewed it. Are your practice and pricing details up to date? Is your software running on a newer update than it was on when you put the guide together? Are you working with any new insurance networks with particular specifications?
Take frequent opportunities to update, modify, and improve your billing process and make sure all changes are reflected in your guide. At minimum, you should review your policy guide quarterly to keep it up-to-date. At best you should go back to it much more frequently to add more thorough information.
Ideally, your billing policy guide is a living document in which you and your staff continually input greater and greater detail on your process. The more information available in the guide, the more useful it will be as a training tool and the more likely it will be to help you avoid denials.
And if you need more help working with payers, consider how utilizing a medical billing service can streamline processes at your practice.