Medical Billing Process
Gathering Key Data
When a patient calls or goes online to schedule an appointment, they have decided it’s time to address a health issue. This means they are willing to provide whatever information is necessary to ensure their issue is addressed in a timely manner.This is the best time to collect as much information about the patient as possible including:
Contact information for both the patient and the enrolled party (in the event of employer-based, family health insurance coverage)
Health insurance coverage details including network, type of plan, coverage-effective dates, group and member identification numbers, and insurer contact information
Patient communication preferences for appointment confirmations, reminders, etc.
Registering Patients
For most medical practices these days, healthcare information technology streamlines patient registration. It allows staff to email or text an appointment confirmation by providing a link through which the patient can access a secure patient portal. Patients can complete such tasks as:Confirming contact and insurance policy information
Acknowledging receipt of the practice’s privacy and financial policies
Confirming the patient’s permission for the practice to share claim-related medical information with payers
Sending messages to, or accessing messages from, the medical practice
Accessing patient educational materials recommended by the practice
Reviewing medical practice invoices and claim-status updates
Requesting or accessing new prescriptions or refills and provider referrals
Verifying Eligibility
Healthcare information technology has improved revenue cycle efficiency dramatically. However, it cannot replace thorough staff training and motivation in engaging the patient and getting the medical practice paid. One crucial part of the latter process is verifying the patient’s health insurance coverage.PracticeAdmin allows for seamless integrated eligibility to drastically reduce the time to complete the task of checking eligibility. Other products may require you to call the insurer or go online to confirm not only that the patient is covered, but also that they are covered for the procedure or visit type scheduled. If your software does not handle eligibility verification for you, questions to ask during verification should include:
If the treatment plan requires a series of visits, what’s the maximum number of visits allowed?
Is prior insurer authorization required before treatment will be covered?
Is there a deductible the patient must meet before coverage begins and, if so, how close is the patient to meeting it?
After the deductible is met, what percentage of total treatment costs must the patient cover out-of-pocket?
Does the patient have secondary insurance coverage?
Asking these types of questions — and verifying them at each visit — might seem like overkill to your medical practice staff. This could help explain why only a quarter of practices verify patients’ insurance coverage for repeat office visits. However, the answers can, and often do, affect practice revenue.
Insurers routinely deny about 20 percent of medical claims according to Kaiser Health News. Failure to verify insurance coverage is one of the denial reasons cited most often. Medical billing industry experts note that reworking a denied insurance claim adds between 20 and 30 percent to its cost. Multiply that by all the claims your practice submits in a year and the do-over costs add up.
Healthcare organizations routinely write off approximately three percent of net revenue per year to denied claims, according to MGMA. That’s $30,000 for a medical practice netting $1M a year.
Collecting Co-Pays
Healthcare financial services firm RMP reports that more than 30 percent of patients walk out of medical offices without paying. The firm also confirms that in general, the longer it takes to collect on a patient charge, the less you will be paid for that charge.50% = maximum you can expect to collect if you wait until after services were provided to discuss payment
33% = what you’re likely to collect by sending statements at 30 to 120 day intervals after treatment
16% = average amount collected after turning patients over to a collections service
Additional healthcare industry collections data indicate the likelihood of collecting a past-due account decreases by at least 10 percent every 30 days. Clearly, if your practice doesn’t attempt to collect either before or during the treatment interval, it has missed the boat to optimizing profitability. As uncomfortable as it might seem, think of your medical practice as a profit center. This is what’s required in today’s dynamic healthcare marketplace.
Collecting the full, negotiated rate at the time of service makes for greater practice profitability. If you are unable to collect at the time of service, you can use a tool like PracticeAdmin’s patient portal to allow your patients to pay easily after the service has been performed. Maximize profitability by teaching your staff that the revenue cycle begins long before the patient sets foot in your office.
