Many Medial billing company struggles or failed to increase the revenue of Practice or Hospital. Here we have listed top ideas can implement which really increase the revenue of provider , practice or hospital whether its in house or Outsourced Medical Billing.
1.Patient Eligibility Verification
Make sure doing Verification prior to face to face encounter would eliminate any non coverage problem and denial.
2. Reminder to Scheduled patient
Sending a remainder via text would be a good idea rather than billing no show fee which cause a problem patient goodwill.
3. Collecting upfront
Doing prior verification would help us decide copay and other patient responsibility. Have a process of collecting copay from patient when patient comes in for visit by front office staff.
4. Coding review
Someone has to do the coding review takes a major part in submitting clean claim. Use appropriate modifier were ever is required. CPT and ICD combination has to be correct to avoid any Medical necessity or additional document record denial.
5. Pre - Claim Edit
Most of the software and clearing house Pre - claim edit. Make full use of it.
6. Charge Entry Process
Has to be well trained person and should have basic coding Knowledge is important to entering charge as a clean claim
7. Claim Submission
Every day claim submission is recommended.
8. Working on rejection
This should be the top priority work by AR specialist on everyday.
9. Posting Payment
Convert as much as ERA that would reduce the time tremendously.
10. Denial Management
Have a dedicated time work on Denial , all the denial has be worked on the same week.
11. Re submission
Do the re-submission then there as corrected claim.
12. Getting payments on time
This point is very important factor as we need to download the payment EOBs on time to reduce the work on AR.
13. Patient statement process
Sending weekly statement is make huge difference is patient collection. Follow the cycle method.
14. Claim Follow up
We need to know the each and insurance response time period and start the follow up once it crossed that time. Now a days insurance started to respond within a week hence 15 -30 follow up would be a good practice.
15. Creating our own insurance login
This is very much helpful to check the claim status by online which is more time and cost effective.
16. Online checking
Do the claim follow up and verification through online as much as possible.
17. Call IVR/AVR
Make use of it
18. Calling follow up.
Provider Details required before calling the insurance. Provider Tax id, Provider ID, NPI and of course patient information and service information.
19 Fax follow up
Some insurance allow fax status claim follow up, we could use it for that too.
20. Appeal the claim
Group the claims which need to appeal and send it weekly basis that would be organized manner and time efficient too. Don't forget the follow up with appeal on time otherwise it would go beyond the time limit.
21. Timely filing limit.
Our Aim should be 100% submission and followup before TFL approaches. So there should be alarming method to if any claim approaches near TFL period.
22. Pre - Template appeal form
Always has Pre - template appeal for most often used reason and just fill up the insurance and patient information alone.
23. Pay to address
Always we make sure that any insurance has our pay to address and practice address right information.
24 Changes in address
If any changes in address in clinic, pay to address. Inform it to all insurance and all vendor like clearing house. Plan before to avoid any time delay.
25 Keeping old address Accessible
Even we moved to new address, we should have the access for old premises for at least 6 month. Maintain a good relationship with old address premises so that they would collect any letter behalf you.
26 Make it Electronic
Be it ERA, EFT, EMC. Going Electronic is far better than paper method.
27 . Secondary Claim Submission
Once we receive the primary insurance payment, we have to submit the left over balance to secondary payer. People not giving much importance secondary claim but it should happen every week.
28 Identifying specific situation
Identifying specific situation and crate a separate rule is good option. Like some insurance require group number in CMS 1500 Claim
29 Organized Data
We should maintain our data organized by insurance and provide hence it would be ease to find it.
30 Inclusive code
Always have a update on inclusive code and non separately paid codes and take write off during payment posting itself. Make sure its 100% non paid procedure, some of the CPT can be paid by using modifier or difference in ICD.
31 High value claim
Our High value claim need to give more attention and follow up in every week.
All staff has to educated every 15 days or a Month. All are has to be updated with current information
33 Billing Changes in claim format
Any changes in billing concept has to planned well and require follow up in every stage. Do the testing before claim submission and talk with clearing house and make sure changes are reflected in claim format.
34 Up coding or down-coding
Don't up-code which is not going to bring a revenue in the longer run. Always go by record and make sure we are not down coding as well.
35 Software database.
Always made changes in database like deleted code and use the date filter in software.
36 Fee schedule
Try to have a different fee schedule for patient biking and different insurances.
37 Collect patient e-mail
We can use it for Electronic patient statement and for communicating with patient.
38 Working on Clarification
Any claim which required clarification from provider or any other source would required immediate attention and work on it.
39 Find out top 10 denial
Find out Top 10 denial and have a plan of action in each department to reduce the chance of getting denied.
40 Authorization process
Identify the procedure requires Authorization and get it at least 3 days advance . If any changes in Authorized procedure and performed procedure required immediate intimation to insurance before submitting the claim.
Medical billing is ongoing learning process hence keep on update yourself to improve and increase the revenue of Practice. Use comment section for any other ideas and feedback.
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