5 Tips to Obtain the Highest Value from Medical Claims
Providing the best possible care to help patients get on their feet and back to optimal health is the priority of any medical practice. At the same time, it is important for the health of a medical practice to make sure it is maximizing its revenue through effective billing. Here are some tools and rules a medical practice can implement or utilize better to improve its bottom line.
Modifiers
Proper use of modifiers can indicate the complexity, necessity, or special circumstances of a procedure, which may result in higher reimbursement from insurance companies. They help in breaking out warranted services so that each item is captured and billed appropriately.
Medical Billing Software
Choosing billing software that is specific to the medical industry will help any practice from start to finish - from collecting appropriate patient information to running performance reports to see where there could be issues to correct. It is an invaluable asset to help a practice properly document and capture all billable services and procedures so claims are submitted at the highest value available.
Outsourcing
Is your practice able to stay current on medical billing compliance and coding changes? Does your staff know how to handle denied claims? If the answer to either of these questions is no, then your practice may be under collecting. It is important for a medical practice to evaluate if it has the proper resources, time and staff allocated to maintain a steady revenue cycle.
Coding
Medical coding requires precision, knowledge of compliance standards and a commitment to ongoing education and training. A well-trained billing team has the coding expertise to discern documentation, code cleanly (& quickly) and capture the details of complex services. Make sure your practice is providing the resources and training to support your coders, starting with comprehensive and clean documentation. Proper coding is fundamental to a medical practice obtaining optimal reimbursement.
Auditing
Whether it is monthly, quarterly or a timeframe of your choosing, routine auditing is crucial to the success of a practice’s medical billing process. In part, audits allow the practice to identify mistakes, missed charges and bottlenecks that, once addressed, can significantly increase revenue capture. Incorporating a regular auditing process can also be used to negotiate better reimbursement rates with insurance companies because the payers recognize the commitment a practice is taking to be accurate and compliant.
Gaining the most out of your medical billing requires a comprehensive approach, involving both technology resources and human expertise.