How to Improve Your Medical Claims Billing Process

Did you know that approximately 80% of medical bills in the US contain errors? Most errors are due to incorrect ICD-10 codes or inaccurate patient data. These errors not only cost your practice money but also impact your patients’ well-being.

If you’re having trouble with the medical claims process, it can be challenging to know where to focus first. The good news is you just need to learn the best tips and tricks to get you moving in the right direction.

Keep reading this guide to learn everything you need to know about improving your medical claims billing process!

Update and Maintain Patient Files

Remember, how will you ever manage your medical claims billing if you don’t have the correct patient data?

The best way to handle this is to improve your patient check-in process. Ensure your staff verifies all patient demographics and insurance information at every visit. It’s best to double-check all the details like:

• Policy number
• Policyholder name
• Insurance company information
• Insurance company billing address and phone number
• Have the patient repeat their current address and phone number

Doing this is essential because a patient might change jobs and get a different insurance provider.

It’s also possible that a patient might switch their coverage to their spouse’s insurance. In addition, their insurance policy might have changed if they upgraded or downgraded their plan.

Create a Transparent Collections Process

To ensure the financial health of your medical practice, you’ll need to establish a step-by-step collection process for all the procedures involved in filing claims. It’s the best way to eliminate communication issues as being the reason for non-payment.

It’s a good idea to follow steps such as:

• Inform your patients about their responsibility to pay debt insurance doesn’t cover
• Get permission to leave a message on their voicemail for bill collection matters
• Remind patients about co-pays and be sure staff is trained to answer questions
• Collect co-pays based on deductibles upfront
• Communicate available payment methods to the patient
• Verify insurance eligibility with every visit
• Send a sequence of letters and reminders to patients with a bill coming due
• Call and send a final letter before sending the bill to collections

You might have to modify this process to suit your particular medical facility. This is because some specialty areas don’t see patients face-to-face as often. 

Track Claim Denials

The submission and rejection of a claim can take weeks. Additionally, editing a claim and resubmitting it can take even longer. As a result, you could potentially have to wait months before receiving payment for your providers’ services.

Having a system in place for your denials will allow you to get a good handle on your denial rates. It will also give you insight into improving your processes even further.

If you see high denial rates, it’s a sign to look into your process more and provide advanced training to your team. It may also mean you need to evaluate the current workflow. 

The most common reasons for claim denials include the following:

• Incorrect patient information like insurance or birthdate
• Incorrect insurance information like the policy number and address
• Duplicate billing
• Poor documentation of a visit or procedure
• Coding errors
• Services not covered by insurance
• No insurance preauthorization

Automate Certain Billing Functions

Make sure to use technology to your advantage and automate monotonous functions that slow your staff down. Tasks like issuing and generating payment reminders, filing individual claims, and selecting codes are the easiest to automate.

Medical software billing systems can handle numerous other tasks seamlessly, such as:

• Sends text reminders to patients about upcoming appointments and records their replies
• Scans documents like insurance IDs and driver’s licenses
• Provides a mobile app that’s easy for your patients to use
• Automatically alerts you if a patient is out-of-network
• Automatically verifies insurance eligibility
• Allows you to resubmit denied claims instantly

The bottom line is that medical billing software can improve reimbursement rates and free up your staff for other tasks. As a result, you’ll improve your finances and revenue long-term.

Improve Quality Control

Finding and eliminating claim errors is essential to improving your billing process. To improve this process further, it’s best to form quality control policies and procedures.

One way you can do this is to focus on accounting accuracy. One solution could be creating a log for each payment received from a patient before it’s sent to the billing team.

Your logs should include information like:

• Account number
• Patient name and date of birth
• Whether the payment was by cash or credit card
• The amount due
• Date of service

Additionally, you’ll need to identify problem accounts. Typically these patient accounts have a history of late payments, declined payments, or frequent phone number and address changes.

Outsource Your Billing and Claims Process

You should consider outsourcing your billing if you’re a small medical practice with limited staff or need help with claim denial management.

Also, it’s best to outsource the process if you have a challenging billing process because you’re a federally qualified health center (FQHC). You can check out FQHC billing for more information.

Medical billing companies give you access to experienced medical billing and coding specialists. These specialists are certified and must keep up to date on all the latest ICD-10 code changes.

Other benefits of hiring a medical billing company include the following:

• It saves you money on salaries and training staff
• It saves you money on upgrading equipment and software
• Reduces costs by submitting your claims on time
• Offers claim denial management
• Reduces billing errors
• Offers you financial help with accounts receivable management
• You’ll have more time and money to invest in other aspects of the business  

Improving Your Medical Claims Process

Now that you have some tips on improving your medical claims process, you can start taking steps today to make changes.

Don’t be afraid to seek professional help and outsource your claims process, even if it’s only temporary. You’ll be able to get the entire process under control and determine if it’s a long-term solution for your facility.

To learn more business and financial tips, check out the rest of our blog today!