As a small or independent medical clinic with only a few providers, you may have run into issues with medical billing that result in a lower collection rate and missed revenue. The reality is that many clinics just settle for lower reimbursement rates, feeling good about capturing 60 to 70% of billed charges, because trying to improve revenue cycle management seems daunting.
We won’t tell you that coding and billing are easy in a medical clinic, but there are a few ways you can improve the process and workflow to increase total revenue capture.
1: Make it Everyone’s Job to Improve Medical Coding and Billing
One of the biggest challenges for small clinics is the volume of denied or rejected claims. When a payer rejects a claim, it requires a lot of extra work for someone to track down the problem and resubmit it (and most clinics are doing this manually). There are tight deadlines to resubmit, so for understaffed clinics, that could mean missed claim resubmissions and lower revenue.
Most mistakes that lead to rejected or denied claims could be easily avoided. Some examples of common reasons payers deny or reject a claim include:
- Incorrect patient information (name, address, SSN)
- Incorrect insurance information (incorrect ID, expired coverage)
- Errors in primary or secondary insurance coverage
- Coding or documentation errors
- Inadequate documentation to prove medical necessity
- Missing preauthorization codes
- Missed deadlines for filing a claim
- Not meeting payer-specific requirements
Most of these errors could be corrected early in the process.
- Front desk staff should verify insurance and eligibility, collect copays, and verify patient demographics before the visit occurs.
- Clinical staff should double-check that they have included all the necessary documentation before sending a claim to the billing department.
- Providers need to include all appropriate information to prove medical necessity and be as specific as possible.
- Coders and billers need to understand the specific requirements of each payer to ensure accuracy and avoid missing deadlines.
2: Use a “Claim Scrubbing” Service
There are third-party services available to double-check your claims before submission. These services flag potential errors so you can fix it before sending it to the payer and avoid denials and rejections for simple errors.
3: Consider Outsourcing
It’s difficult for a single medical coder or a small team to have the time and expertise required for an increasingly complicated medical billing system. If your team is having trouble keeping up, outsourcing to a third party medical billing company might help. There is a cost, but many guarantee a much higher collection rate, which can more than make up for it. Plus you won’t have to pay salaries and benefits for internal medical coding and billing employees.
To learn more about how your practice management software can improve medical billing in a small clinic, or find an outsourced medical billing company, talked to AdvancedMD today.