Medical billing has now become a crucial part of the healthcare industry. The medical Billing process refers to submitting and following up on claims by third-party companies to obtain payment for the healthcare service. The earlier billing process was done on paper, but now every medical billing company keeps the health information in systems.
Error in billing processes can make huge differences that may result in rejection or denial of the claim. According to data, up to 42% and 19% of claims are denied due to incorrect coding and improper documentation, respectively.
Steps to Create the Medical Billing Process
Several processes are involved in claiming collectively called billing cycle or sometimes Revenue Cycle management. But one should focus on obtaining timely payments and minimizing the expense with the help of effective management. Following are the factors that need to be considered to rationalize the billing process:-
1. Conception of process
Before starting anything, you need to understand the significance of every step of processing. It’s your responsibility to avoid deceptive results with timely and finalized submissions. The process must begin from the appropriate collection of patient information related to co-payments, coinsurance, and deductibles.
Verification of documents and checks for eligibility must be actively scrutinized. Coders need to verify the selected codes for the claim before submitting it to the insurance carrier. The rejected, denied, partially paid claims need to be efficaciously managed.
2. Analysis of process
Different insurance companies have different sets of rules and procedures for claiming. For example, the insurer demands chart notes for different purposes such as primary care, follow-up care, or non-standard treatment protocols. The reasons behind the denials of claims might be improper credentialing of physicians, inappropriate documentation, or irrelevance of codes for carriers.
3. Staff performance
The role of staff is highly appreciable for the claims to be successfully paid. But this is only possible for well-trained and skilled staff to bring productive results. The company should incorporate various employee training programs for the billing department. It helps in enhancing their understanding of the collection of relatable and right documents for timely submission.
4. Verification before submission
There should be no scope for mistakes in the verification of documents and details. Corroboration of all codes needs to be done properly; otherwise, it may result in denial of the claim. Emphasizing correction at every stage before submission will bring greater chances of success.
5. Technical support
Several medical software options are available to streamline the vigorous process of billing. The use of software has simplified various steps by providing suggestions of codes and checking claims against the payer’s rule. The digital transaction has excellently assisted the patients. Automation in demographics, integration of patient self-service applications, electronic medical records, and functionality of the portal has made the flow of administration more reliable.
Medical billing companies provide great assistance to the healthcare provider and patient. The patient doesn’t need to clench with the hustle-bustle created while chasing the insurance company for payment. Billing companies need to be up to date on billing regulations and valuable resources to obtain the best outcomes.