Getting healthcare reimbursements quickly after helping patients is super important for both large and small healthcare practices.
Some small healthcare providers worry about hiring third-party medical billing companies because they think it will cost too much. If you’re one of those people, it’s okay!
We’re here to give you a simple guide with tips and tricks for medical billing and coding. Once you follow them, you can easily handle medical billing and coding at your healthcare practice with your own team. First, let’s learn how medical billing works!
Learning About How Medical Billing Works
Before we dive into medical billing tips for healthcare practices, let’s first understand how the clinical billing process works. Medical billing and coding might look tough at first, but it’s not super complicated! Your team can handle medical billing without it affecting their main job, which is taking care of patients.
The medical billing process involves various entities working together to ensure proper payment for healthcare services. Here are the key steps:
- Patient visits healthcare provider (physician, hospital, etc.) and receives medical services.
- Provider’s billing staff verifies the patient’s insurance eligibility and benefits through the insurance provider’s portal or by phone. They identify the patient’s copays, deductibles, and coinsurance amounts.
- The provider assigns standard medical codes (CPT, ICD-10, etc.) to the services rendered and inputs them into practice management software along with relevant patient and insurer information.
- The practice management software checks the codes for errors and verifies compatibility with the insurer’s system. It then sends the claim electronically to a clearinghouse.
- The clearinghouse scrubs the claim further for errors and converts it into the proper format for the specific insurance company. The claim is then sent on to the insurer.
- The insurance company reviews the claim and supporting documentation to determine if the services rendered were medically necessary. They verify that correct codes were used.
- The insurer makes a determination to pay or deny the claim, in whole or part, based on the patient’s policy. Explanations of benefits (EOBs) are sent to the provider explaining the decision.
- For approved claims, the insurer sends payment to the provider. The patient is billed for any remaining copays, deductibles or coinsurance.
9 Proven Medical Billing and Coding Tips and Tricks for Small Healthcare Practices
Doing medical billing and coding at your healthcare practice is quite simple. Small healthcare providers can handle billing and coding on their own with these easy tips and tricks.
1️⃣ Write down patient info correctly.
First, we need to add the latest patient information, like their name and address. If you send in claims with wrong information about your patients, your healthcare practice could get in big trouble with denied claims and rejections. If you send in claims with wrong information after giving care, it can cause billing mistakes. This can lead to less money and lower performance for your practice. Insurance companies won’t look at billing claims that have mistakes. They will likely reject them, causing a prolonged billing procedure.
So, to avoid the trouble of claims getting rejected or denied, physicians need to write down patients’ information correctly. Your billing team needs to check information often. The patients’ information that should be confirmed before or after giving services includes:
- Patient’s name
- Date of birth of the patient
- Patient’s insurance ID number
- What’s the patient’s phone number and address?
You can verify the above patient information in several ways. The simplest way to check this info is by sending a digital form to your patients. They can fill it out easily before their treatment. There are different software options you can use, and they work well with your practice management software. You can make special data sections for each patient to make sure all their information is 100% correct. It will help stop mistakes and wrong information when you send in claims.
2️⃣ Check the patient’s insurance plan.
Once you’ve checked and entered the patients’ information, the next step is to make sure the patient’s insurance plan is acceptable and that they are eligible for it. For example, see if their insurance plan pays for the treatment they are getting or will get.
Remember, insurance eligibility and insurance verification are not the same things. They are not the same, but both are important steps. Insurance verification is checking if a patient can get care services with their specific insurance plan from a certain insurance company.
On the other hand, insurance eligibility is about looking at a patient’s healthcare plan to see if it covers the treatment they need. For example, some insurance providers don’t cover mental health therapy services. Insurance eligibility also includes verifying the remaining benefits on the patient’s current health plan before treatment.
Also, as a healthcare provider, you should tell your patients how much their insurance will pay and how much they need to pay for their treatment in the name of “copays”. You should definitely tell your patient about it! Assuming that your patients might know is an unwise move.
You can quickly find out what insurance your patients have in a few simple ways, like:
- On the insurance company’s site
- via a clearinghouse
- via BMB insurance verification software
Furthermore, if a patient does not have insurance, you should properly instruct them on how to make payments from their own pocket. Communicating clearly with your patients in such matters can build their trust in your practice, and thus, you can also increase the ratio of patients’ appointments.
3️⃣ Make payment rules easy to understand.
Set clear terms for patient payments. For example, your patient has to pay $50 as a copay after confirmation from them and their insurance. Now, you have to get this payment as soon as possible. Just do these steps to get your payments right away:
First, let the patients know how much they need to pay and when and how they can do it. When they check in, let them know how much their copay is. It’s fine to ask for payment upfront, but you can also give them some options if they can’t pay right away.
Next, it’s important to set up a way to talk to patients if they can’t pay when they come in for their appointments. Make sure to send patient statements if you need to. Patients may need to pay a copay, but sometimes insurance companies might not pay for the services the patient got. So, that means patients have to take care of all the payments.
4️⃣ Type in the right codes.
Before you send claims to insurance companies, make sure to check the CPT, ICD-10 codes, related Modifiers, and any other codes. Getting better at medical coding is really important for making sure medical bills are correct. But for small practices, it can be tricky because they don’t have enough staff to have someone just for coding. To boost your cash flow and keep your money coming in, you need to do it the right way.
As a medical coder, you need to be careful to avoid mistakes like upcoding, undercoding, billing twice, forgetting modifiers, and making sure the services are necessary (i.e medically necessary).
Check out these tips to help you avoid mistakes in medical coding:
- Double-check all medical codes before submitting a claim to payers.
- Ensure that all patient information is accurate and aligns with coding data entered in medical bills.
- Make sure not to bill twice by clearly noting each treatment and when it was given.
- If you have any questions about a medical service for covered patients, just ask the provider!
5️⃣ Submit claims in a timely manner.
Faster reimbursement requires you to submit claims faster. Send in your claims fast so you can get paid back for your care services on time! Practicing like this gives you more time to deal with rejected claims.
Insurance companies usually want medical practitioners to send in claims within 90 days after giving care. They can say no to claims if doctors don’t send them in on time.
So, make it a habit to prepare bills and send claims right after patients’ appointments. Make sure to code the medical procedure within a day after it’s done and send in the claim within a week after that. Have someone on your team check if the claims are accurately submitted.
6️⃣ Use combined EHR and medical billing software.
Using technology can help small healthcare practices with medical billing and coding a lot! To get paid back quicker by insurance companies, hospital and physician offices should put medical statements and records all in one system. For example, EMR can work together with billing software that keeps all patient charts and billing info in one place.
It will help with billing tasks, take care of claims, and give you billing information that can cut down on mistakes and save time. The EHR system makes it easy to manage patient records, billing information, and submitting claims. It can help cut down on paperwork and make things more accurate. If you’re a healthcare provider, you can get paid faster by connecting your EHR and billing systems. This helps both patients and payers!
7️⃣ Stay updated with the payment trends.
Staying updated with payment trends allows you to collect payments faster and improve patient satisfaction. Let’s make it super easy for patients to pay!
Some of the patient’s payment trends include:
- Conduct patient surveys and feedback reviews to understand patients’ payment pain points and preferences. Get input directly from your patient population on what they expect from the payment process.
- Track changes in payer policies and regulations around payments, billing codes, etc. Stay on top of updates from Medicare, Medicaid, and private insurers that impact your reimbursement and patient collection amounts.
- Follow healthcare finance publications and industry resources to learn about emerging payment models and technologies. Value-based care, price transparency tools, and digital payment platforms are key trends.
- Attend healthcare finance conferences and seminars to network with peers and industry experts. Discuss current challenges and innovations in optimizing the patient payment experience.
- Leverage patient payment analytics from your practice management system. Evaluate metrics on payment method utilization, collection rates by payer, patient balances, and more.
- Pilot new payment tools and technologies that align with patient preferences. Test digital payment apps, online billing portals, payment plan options, and other innovations.
- Educate staff on payment trends and equip them to address patient billing concerns. Provide training and resources to improve front-end staff’s ability to provide billing transparency.
8️⃣ Stay compliant with regulations.
Standard security procedures and regulations are subject to change, and small healthcare clinics may not always comply with them. To follow the rules for medical billing, make sure to check the regulations often. This includes things like HIPAA, the False Claims Act, the AKS, the No Surprise Act, and the rules for Medicare and Medicaid billing. If you don’t follow the rules for medical billing, your claims might get rejected, which can hurt your practice’s revenue flow.
9️⃣ Give your staff training on how to bill correctly.
A great way for small healthcare providers to make their medical billing and coding better is to teach their staff about the best billing practices. Your team at the medical office should learn all about medical billing and coding really well. Teach your team or choose 3rd party medical billing companies like BMB. They provide full billing and coding services and can help train your staff too!
Your employees should be well-versed in:
- Medical Billing and coding (various codes related to practice specialties)
- RCM (revenue cycle management)
- Submitting clean claims
- Using different software for medical billing
- Prior authorization and insurance verification techniques
- Keeping track of accounts receivable and checking on claims that were turned down or denied.
🌟 Hire us to handle your medical billing and coding needs
We talked about some helpful tips for medical billing and coding. These tips can help healthcare providers manage their billing with their own team. If you want super accurate results, let BMB handle your Medical Billing and coding services. This Best Medical Billing company helps healthcare practices by offering complete billing services.
The skilled coders and billers at BMB make it easy for you to get paid for the care you give to both in-network and out-of-network patients. They make sure you get your money back fast by using their skills and smart billing software.
Maximize your revenue growth by outsourcing to us today.
