Billing is an integral part of healthcare that affects patients, providers, payors, and revenue cycle staff. It plays a role in care efficiency, patient experience, and of course—the financial viability of each medical practice. In this blog post, we’ve distilled years of firsthand and consulting experiences into 6 best practices that every healthcare practice should implement to optimize healthcare billing and enhance financial sustainability.
Best practice #1: Verify eligibility and benefits upfront
Verifying eligibility and benefits upfront is essential for ensuring financial sustainability, compliance with regulations, and providing a positive patient experience in medical practice. Make it a priority to proactively review patients’ insurance coverage and benefits to determine eligibility and any potential financial responsibilities.
Include these essential steps in your eligibility and benefits verification process:
- Optimize your Patient Pre-registration Process: Gather basic patient information, including name, date of birth, social security number, and insurance details during the pre-registration process. Encourage patients to bring their insurance cards and identification. (Check out our post on improving the patient registration process for more tips).
- Develop a Process to Alert Patients of Financial Responsibility: Communicate with patients about their estimated financial responsibility before or during their appointment. Inform them of any copayments, deductibles, or coinsurance they may be required to pay at the time of service. Offer patients written estimates of their out-of-pocket expenses if possible. This can help them plan for their healthcare costs and reduce surprises.
- Prioritize Communication with your Billing Team: Establish effective communication channels between the insurance verification team and the billing department to ensure that billing is done accurately based on the verified information.
By following these steps and maintaining a well-organized and efficient eligibility verification process, your medical practice can reap the following benefits:
- Fewer billing errors
- Fewer denials due to coverage issues
- Reduced time between service delivery and payment receipt
- Greater transparency with patients
- Improved patient satisfaction and engagement
Best practice #2: Require accurate and detailed documentation
Document all patient encounters comprehensively, including diagnoses, treatments, and services provided to support proper coding, billing, and reimbursement. Set up consistent chart reviews to catch one-off issues and identify persistent errors.
Check out our post on reducing revenue loss through documentation improvement for more details on common missteps we’ve seen in documentation lately, reasons to invest in improvement efforts, and best-practice strategies for transforming clinical documentation practices at your organization.
Investing in documentation improvement delivers the following benefits:
- Reduced claim denials
- Improved operational efficiency
- Reduced risk of fraud, abuse, or penalty
- Limited disruption to cash flow
- Maximized reimbursement
Best practice #3: Ensure proper coding and charge capture
A healthy revenue cycle requires assigning accurate medical codes to procedures, diagnoses, and services performed and complying with coding guidelines, such as the International Classification of Diseases (ICD) and Current Procedural Terminology (CPT).
These strategies help ensure proper coding and charge capture include:
- Use Certified Coders: Employ certified medical coders who are well-versed in ICD-10, CPT, and HCPCS Level II codes. Certified coders are more likely to be up to date on coding changes and best practices.
- Develop a Coding Compliance Plan: Develop and implement a coding compliance plan that outlines your practice’s commitment to accurate coding, billing, and adherence to healthcare regulations. Regularly review and update this plan.
- Conduct Regular Audits: Conduct regular internal audits of coding and billing practices to identify coding errors or inconsistencies. Correct any identified issues promptly. You may also consider engaging third-party auditors to perform external audits periodically. This can help uncover potential compliance risks and coding inaccuracies that may go unnoticed internally.
- Invest in Claims Denials Management Keep a close eye on claim denials and analyze them for recurring issues. Use denial trends to identify areas for improvement in coding, documentation, or charge capture.
Benefits of proper coding and charge capture include:
- Increased revenue cycle efficiency
- Limited revenue leakage
- Improved compliance
Best practice #4: Commit to timely claims submission
Timely claims submission can be extremely valuable to medical practices because it minimizes cash flow disruptions, reduces claim denials, ensures compliance with payer regulations, and enhances both the practice’s revenue cycle management and the patient experience. We suggest defining and communicating clear internal deadlines for claims submission, preferably within 24-48 hours of service delivery.
A few effective ways to ensure timely claims submissions include:
- Leverage Technology to Automate Claim Generation: Use automation tools within your EHR or practice management software to generate claims automatically based on patient encounters. This reduces manual data entry errors and speeds up the process.
- Verify Insurance Eligibility Upfront: As mentioned previously, verify insurance eligibility and benefits before the patient’s appointment. This allows you to identify any coverage issues and address them proactively.
- Streamline the Claims Review Process: Establish an efficient internal process for reviewing and double-checking claims before submission. This helps catch errors or omissions early, reducing the likelihood of claim denials.
- Use Electronic Claims Submission: Whenever possible, submit claims electronically (e.g., through a clearinghouse or directly to payers). Electronic claims are processed faster than paper claims, leading to quicker reimbursements.
- Outsource Billing Services: If managing billing in-house proves challenging, consider outsourcing billing services to a reputable medical billing company with expertise in timely claims submission.
Benefits of committing to timely claims submission include:
- Avoidance of processing delays
- Fewer denials
- Reduced likelihood of revenue loss
- Improved patient experience
Best practice #5: Implement effective denial management
Proactively set up a structured denial management process to track, analyze, and resolve claim denials. Develop a systematic approach to review denials, gather supporting documentation, and submit strong appeals within the specified period. Enlist staff to categorize denial reasons and develop action plans to prevent recurring denials.
Check out our post, 5 Highly Effective Denials Management Strategies, for a step-by-step breakdown of how to handle denials, insights into denial prevention, and five proven strategies to transform your practice’s denial management strategy.
The benefits of improving denials management include:
- Maximized reimbursement
- Improved patient experience
- Limited disruption to cash flow
- Highlighted opportunities for process improvement
Best practice #6: Prioritize patient communication and education
Prioritizing the patient’s experience in medical billing is not only ethical but also strategically valuable. It enhances trust, reduces patient stress, improves compliance, and contributes to the overall reputation and financial stability of healthcare providers and billing companies. Patients who have positive billing experiences are more likely to engage with the healthcare system effectively, leading to better healthcare outcomes.
These are a few best-practice ways you can prioritize patient experience in your medical billing process:
- Issue Clear Billing Statements: Create billing statements that are easy to understand, with clear explanations of charges, insurance adjustments, and patient responsibilities. Avoid using medical jargon whenever possible.
- Provide Transparent Cost Estimates: Offer patients accurate cost estimates for services or procedures, including any out-of-pocket expenses they may incur. Transparency in pricing helps patients plan for their healthcare costs.
- Ensure your Billing Staff Offers Compassionate, Accessible, and Timely Customer Service: Train billing staff to be empathetic, patient, and respectful when dealing with patients’ billing inquiries or concerns. Ensure easy access to customer service through phone, email, or online chat. Or choose a third-party billing partner who prioritizes empathetic, clear, and accessible customer service. Beyond compassion, make sure your customer service is also timely. Set clear response time expectations and adhere to them.
- Offer Payment Plans and Financial Assistance: Offer flexible payment plans and financial assistance options for patients who may have difficulty paying their bills. Ensure that these options are clearly communicated to patients.
- Have a User-Friendly Patient Portal: Provide an online patient portal where patients can access their billing information, review their statements, and make payments conveniently.
- Communicate with Patients and Make it Easy for Them to Offer Feedback: This includes:
- implementing billing transparency policies that clearly outline how billing is handled, including how charges are determined and how insurance claims are processed,
- collecting patient feedback through surveys or feedback forms to understand their experiences and identify areas for improvement,
- and establishing a clear and efficient process for resolving billing disputes or discrepancies.
There are many benefits of prioritizing patient experience in billing, including:
- Greater patient retention
- Less patient complaints and disputes (which equals more practice efficiency)
- Increased patient referrals
- More positive practice reputation
Best-Practice Medical Billing Has a Real Impact on your Practice’s Health…
Need more evidence?
Recent surveys have demonstrated that consumers are ready for a change in claims and billing processes. In fact, half indicated they would change providers to get a better experience with payment processes.
Optimized billing processes are essential for the growth and expansion of healthcare practices, particularly when it comes to their relationships with their patients and communities. Efficient revenue cycle management enables practices to grow patient volumes, expand important services, and cultivate financial stability.
Get started following these best practices and more with Resolv’s powerful suite of highly specialized RCM technology. Learn more.