Medical Billing and Coding

Medical billing and coding are two closely connected features of the modern health care industry. Both the practices deal with the revenue department and the reimbursement cycle. It basically ensures that the health care providers are paid on time for the services they offer to their patients.

Medical coding simulates translation services. Medical coders get the medical reports from health practitioners, which will include the patient’s health condition, the doctor’s diagnosis, a prescription, and all the procedures the doctor has performed on the patient, and convert that into a set of codes, which make up an important part of the medical claim.

How Are Medical Claims Processed?

Claims processing in Medical Billing and Coding refers to the overall work of submitting and following up on claims. You must work on balancing the three P’s – Patients, Providers, and Payers – else you will be suffering a huge loss by coding claims to monetize the treatment offered by the physicians.

What is the process of billing?

The general process of billing starts immediately when a patient approaches your healthcare center.

The important steps of medical billing are:

• The patient gives their personal contact details, insurance card, and completes the demographic form after the inquiry is successful.
• The demographic form collects crucial information like the patient’s name, date of birth, sex, address, contact, social security or driver’s license number, policyholder details, policy sponsor details (if any), and any other additional information about the policyholder. As proof, the patient will also give you a valid government-issued photo ID, so that you can validate that the patient is actually insured and holds legit details.
• Impersonating someone else’s insurance coverage and submitting the claim will involve serious legal actions. Hence, it is the duty of the healthcare providers to verify every patient’s identity against the proofs submitted.
• After the initial paperwork is completed, the patient will meet the physician, followed by the physician recommending and documenting the billable services.
• The coder enters the billable codes based on the physician’s documentation.
• The coding then goes to the biller, who enters the given information into the respective claim form in the billing software.
• After the biller enters the coding information into the software, the software sends the claim either directly to the insurance payer or to a clearinghouse, which sends the claim to the respective insurance payer for reimbursement.

In a nutshell, if you are wondering what are the steps in the medical billing process, then they are

10 Ways To Improve Your Medical Billing And Coding

The victory of your healthcare practice mainly depends on an efficient medical billing process. However, challenges like delinquent claims, complicated processes, and denied claims will sabotage your medical practice’s cash flow.

We have listed the ten essential and important ways to improve your medical billing process.

1. Honest and direct communication

It may seem simple, but it is certainly worth an effort in enhancing your medical billing and coding process. Be upfront about your costs and ensure your communication is transparent and clear about payments with your clients. You must include the payment details in the form that collects your client information.

To ensure timely payments for the diagnosis and the treatment taken at your medical practice, you can beforehand collect the details of your patient’s insurance and validate their insurance eligibility. Whatever is the case, be sure to clearly communicate with your clients.

2. Collect updated patient files

Every time a patient books an appointment with you, make sure that your team validates their insurance details. Things change. A patient who visited your hospital a few months back may have changed their insurer, or upgraded their basic insurance, or could be on a dependent’s policy. In order for your team to be productive and avoid last-minute astonishment (of course a sad one!), educate your team to double-check the patient details, policy information, billing address every time an appointment is made.

3. Plan frequent employee training

Dealing with multiple insurance companies is laborious and tiresome. Every insurance company has its own rules and policies and no two possess the same policy. Your employees need to understand and follow different protocols for completing the claims successfully.

4. Automate repetitive tasks

Billing functions like entering the correct patient information, assigning the right medical billing codes, filing individual claims, creating and deploying payment reminders are mundane tasks that make them great recipients for automation.

5. Track denials

A few common reasons for claim denials are incorrect patient information, lack of important information in a patient’s file, errors in medical billing codes. If you track your previous denials, you will be able to identify the reasons for denials. Fixing them before you submit your new claims will improve your claim approval rate.

6. Analyze delinquent claims

In order to improve your cash flow and revenue cycle, we recommend allocating a dedicated staff member to follow up on claims that have not been paid on time. It will help you understand the reason for delayed payments.

7. Bank reconciliation with allowed amount as per contract

Revenue management and cash administration do not end with claim approvals. In fact, this is one of the important steps of medical billing – ensuring your bank account is credited with the correct amount from the insurance provider. To ease the process and maintain proper records so you can refer in the future, maintain a monetary journal with important details like the patient’s contact, account number, payment details, actual amount, and the amount received every time a claim is approved and cleared of the outstanding payments.

8. Resolve denied claims

Sometimes, irrespective of providing correct and precise information, your claims may get denied due to the inert nature of the insurance providers. At such times, don’t defer the claim process, instead keep all the details handy, follow up immediately, negotiate, and pursue the process till the claims get readily approved. It will help you from losing out on your revenue.

9. Outsource complicated collections

One of the most underrated solutions to improve your medical billing process is to outsource. As the business owner, you get to choose what you want to outsource, either the entire medical billing process to liberate your resources and focus more on patients or outsource the most complicated billings..

10. Avail medical billing services

Outsourcing your medical billing process will look after your revenue cycle. Even better, when you hire a medical service provider from an exclusive medical billing company, you can manage your claims and also streamline your medical billing process. The professionals that offer medical billing services will be trained to handle these situations and can easily walk you through till closure. Legal formalities, optimizing your business revenue, tackling delinquent claims with ease, getting the claims approved on time, resolving denied claims, etc., are their forte.

How Do I Find A Good Medical Billing Company?

If you are on the lookout for an experienced medical billing company, then consider Velan. Velan has more than a decade of experience in the healthcare sector and is a famous medical billing company recognized globally. The company owns the latest technologies and software solutions to process claims without errors. Velan holds #1 Nationally Recognized Medical Billing Certification.

Why outsource to Velan? Anything can go wrong in this huge, complicated medical billing process. Hence, the in-house billing team should carry out medical claim processing exceptionally well and perform multiple audits before submitting claims. If the team is not competitive and clear enough to handle the claims process, then your healthcare center will lose a lot of revenue and suffer unwanted losses. In order to save you from the pitfalls, Velan can help you with providing exceptional medical billing services as we have mastered the process and understand the nitty-gritty of the medical billing process. We help you improve your medical billing process and contribute a huge share to your revenue management cycle.

To know more information, contact us today.