Every medical practitioner thinks twice before establishing their private healthcare practice. And the reason behind these second thoughts is Medical billing. Medical billing is one of the most complicated yet crucial aspects of running a healthcare practice.
The most challenging part of medical billing is regular claim denials and inefficient revenue cycles. However, to cater to these problems, many revenue cycle management firms are coming into existence. This is going to be a huge market in the upcoming years. According to research, the Healthcare Revenue Cycle Management Market is projected to reach USD 372.16 billion by 2032 at a CAGR of 11.72% during the forecast period of 2024-2032.
So, are you planning to start your healthcare practice in the US? But your fear of billing complications is holding you back? Or have you established your small healthcare practice, but you are trying to figure out the billing process for your patients? Then you are at the right place.
In this blog, we will break down how you can deal with medical billing, how to outsource your billing operations, and what potential benefits your practice will get by outsourcing medical billing. Keep reading this blog.
Billing Strategies For Small Practices
These are some strategies that your practice can apply while filing claims for reimbursements.
Verify Information
The first and foremost step in claim submission is to provide the correct details of your patient’s record. Hence, medical practices need to confirm and verify patients’ details before submitting. The insurance payer will deny your request if there is slight incorrect information in the documents. These details may include the patient’s name, insurance coverage, state of coverage (because insurance plans vary from each other in every state), medical history, and billing information.
Coding Errors
Interpreting codes (ICD-10-CM, CPT, and HCPCS ) according to the treatment is again a very complicated task, where most billers make errors. If any employee in your practice is filling claims, they must cross-check the description of each code and confirm if it applies to the claim or not.
On the other hand, ensure that you are applying the correct modifier with your claims. Most practices append incorrect modifiers to their claims, which creates hindrances in their payments and leads to rejected claims.
Immediately Respond to Claim Denials
According to research, almost 60% of denied claims are never submitted. Taking prompt action on denied claims is the most important aspect of effectively managing your practice’s cash flow. There is a good probability that your clinic will get compensated for its services, even though it takes time.
Patient Payment Policies
Last but not least, before filing claims, it is important for practices to cross-check the payer policies and establish clear payment guidelines with your clients. You should make sure that your patients are aware of your payment plans, accepted payment methods, and in case of non-coverage from the payer.
These are a few important points that you must consider while submitting reimbursement claims. However, it does not end here; there are still more things that you should take care such as compliance with the regulatory bodies, ensuring regular audits that will reduce the errors in your claims, and proper documentation of the treatment.
Hiring Medical Billing Services
You must be thinking, what if you still face issues of claim denials, and it is still hard for you to understand the billing process? Then you have the option to seek medical billing services for small practices. But how to find the right medical billing company for your practice? Below are a few steps:
Identify Billing Needs
When you decide to outsource your billing operations, you have to determine your billing needs first. You cannot effectively utilize their services to the fullest extent if you are not aware of the requirements of your practice. Take it this way, if you are establishing a new practice and your practice size is mid to small, you have budget constraints, it is important for you to select a medical billing company that deals with small-sized practices.
Explore Medical Billing Companies
Once you have figured out your practice needs, the next step is to explore your options. First of all, choose a company with a good reputation. Start by reviewing the client’s feedback and recommendations. Additionally, you should review the qualifications and pertinent certifications of the medical billing outsourcing firms you are considering. These tactics are more likely to maximize billing accuracy and expedite payment.
Review Offered Services
After evaluating the reputation of the company, check their offered services. The major question that arises here is whether they are offering services that your practice requires or not. Every billing firm has its own set of services and expertise. Their set of services assists you in selecting a billing firm that may meet your requirements. However, these are a few questions you must ask before making your final decision:
- What are the strategies for their claim submission and management?
- Do they verify patients’ insurance coverage before carrying out the additional services?
- Are they vigilant toward patients’ data? What measures do they take for data protection?
- How do they deal with claim denials, and what is their approach to resubmission of claims?
Benefits of Outsourcing to Third-Party RCM Companies
Of course, there are clear benefits that RCM Companies can provide to small healthcare practices.
Enhanced Cash Flow
One of the most common issues that most healthcare practices face is payment delays and claim denials. Outsourcing to healthcare RCM companies can drastically cut down on the time it takes to get paid by utilizing revenue cycle management services.
Saves Time & Money
The company does not have to invest time and resources in finding and fixing errors later in the process, which also saves money.
Reduces Denials
RCM greatly aids organizations in denial management by lowering errors and providing all the information required. It also reduces the number of claims denied by government payers and insurance companies.
Reduces Administrative Load
Outsourcing revenue cycle management company plays a vital role in reducing the administrative load on a healthcare organization. These companies manage your revenue cycle by streamlining billing procedures and increasing efficiencies.
Conclusion
Being a healthcare practitioner who does not know the business side of running a healthcare practice, it is difficult for you to strategize your finances. But we have high confidence that this comprehensive blog must have cleared your mind about the tactics of filing accurate claims and how to hire medical billing practices.
