Increase Medical Billing Revenue

by Barbi Elmore, Director of Product Development, PracticeAdmin, LLC

Part One of a Three Part Series for Owners of Medical Billing Companies on how to increase their revenue.

Everyday, medical billing managers and medical billing service owners are faced with business and regulatory challenges. Managers must work with front office staff, billing and coding staff, doctors, enrollment departments, and insurance companies just to do their job. Furthermore, it can be a headache staying current with constant changes in healthcare and the looming transition to ICD-10 quickly approaching.

With so much vying for your attention, it’s hard to focus on the most important aspect of any business: the bottom line.One of the best ways medical billing services can get their providers more money is by changing their processes to focus on the 3 R’s of increasing revenue:Reorganize, Retrain, and Renegotiate.

REORGANIZE to automate denial management and payment posting

How well do you understand the denial mix of your providers? Which payers take the longest to pay or respond? Which payers are the fastest to respond or pay? How much of your cash is sitting out in 60, 90, 120+ days? If you could figure out a way to follow-up on 20 percent more of your denials per day, what would that mean to your bottom line?

Stop assigning and working denial by patient last name or payer without knowing your denial mix. Instead use the assembly line method. Split your day and become just one part of the AR chain and make payer calls or check claims statuses online for one to two hours, but don’t finish the task. If the claim is not on file, don’t stop to file it. Just get the status on the next claim, then come back and work it later. If you are part of a larger organization, bring in interns from a local community college, or medical billing and coding school, and give them a script to call for claim status updates. Then your more experienced reps can actually take the action needed on the claim for re-submission.

Stop wait until you received denials before you start making calls. Instead use an internal system to assign importance to claims based on DOS or claim balance. Identify your average days to payment to determine when to start calling, and when to start calling and following-up on claims. It’s faster to first call on insurance Accounts Receivable (A/R) rather than arbitrarily calling after 60 or 90 days.

Stop leaving your denial team over loaded with other responsibilities because they are dialing for dollars, and stop denial hoarding. Instead write off denials faster for better tracking. If it is truly noncollectable, then start the process to write off the charges. Also, give feedback to your offices about non-reimbursable services.

Doctors get in their habits, too, because they need to decide whether services performed are needed for care or just what they always have done. If your provider still insists on seeing the check and the EOB, it’s time to discuss why this leads to slow payments and what can be changed. The longer it takes to post the primary payment or denial, the longer it takes to send to secondary, the longer it takes to send a patient statement.

Stop posting only from manual EOBs and not auto-posting patient payments. Instead automate this process and start utilizing ERAs. Get training from your current software if needed. If you are using ERAs ask your medical clearinghouse for an audit of what payers offer ERAs that you are not currently using; you want to get as close to 100% ERA participation as possible. If you have a patient payment portal ask if they have any interfacing options to your current software as another way to automate patient payments. One final way to automate this process is to find companies and services that will turn paper EOBs into 835 files.

Stop only calling for payor statuses and start using Auto Inquiry features available with with your clearinghouse, and use web portals.

Implement a standardized note structure. One persons note is another person’s confusion, and will lead to multiple calls being made on the same account. How granular you want to get on note structure is based on your organization. But without some type of guidelines staff is left to make their own interpretation.

Get your staff out of the habit of saying ‘That’s the way we’ve always done it’ when working AR/denials. We always want to work smarter not harder! Seems simple enough right? Part of this is process, the other part is attitude. Everyone has to be willing to make these changes inside of your office or department to improve inefficiencies.

Look out for the second R in the 3 R’s of increasing revenue, Retrain.

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