With thousands of medical codes, multiple insurance companies (both private & government), strict policies established by the regulatory authorities and other healthcare evolutions. It’s very challenging for medical practitioners to keep their RCM process optimized. Therefore, the majority of them prefer to collaborate with a top medical billing company.
Reliable billing companies successfully handle the non-core tasks of your medical practice. They manage each and every task efficiently to collect maximum revenue for the healthcare services you provide to the patients.
Just like other businesses, medical practitioners also need a streamlined revenue stream, as well as optimized cash reserves to grow their business in the highly competitive market.
They cannot achieve these goals without having an efficient billing system in place. Medical billing is the process of translating healthcare services into claims and then submitting them to the insurance companies.
Even minor loopholes in the RCM process can hold you back from collecting your hard-earned revenue. Which can negatively impact your financial stability and the business success as a whole.
However, getting reimbursements for the medical care service rendered, from the payers isn’t as easy as it may seem. It requires a considerable amount of time, in-depth knowledge and more importantly experience to manage the billing tasks effectively.
Moreover, due to the growing complexities in terms of medical coding, billing guidelines, and payers’ policies, physicians find it very challenging to stay at the top of the changes. It can be overwhelming for them to manage their non-medical obligations while providing quality healthcare service to the patients.
Therefore, the trend of hiring a top medical billing company has witnessed a surge from the last few years. Here’s how outsourced billers fix the loopholes in your revenue cycle management.
1. Dive Into the Data to Find Leaks
It’s a fact that a high rate of claim denials is the major reason for constant revenue loss. Medical practitioners lose millions of dollars annually just because of inefficient management of medical claims. If the percentage of claim denials exceeds a specified limit then healthcare providers can face an economic crisis such as: revenue loss, cash flow disruption and sometimes collapsed businesses. That’s why physicians are looking for innovative medical billing solutions to keep their claims process tight.
However, when you hire a top medical billing company, you get the services of highly trained professionals. They resolve all the billing and coding issues. First of all, they analyse your existing medical billing system to get a better idea about the areas of improvement.
For instance, they review the denied claims and audit data to pinpoint where the errors are creeping in. To get a complete understanding of the root causes for claim denials, outsourced medical billing specialists track the claim denials by volume, type and payers.
This enables them to identify the problematic areas, whether they are attributable to the front desk staff, administrative workflows, medical coding or billing. It’s pertinent to mention here that the major factors that can lead to claim denials are:
- Healthcare services not covered by the payers.
- Lack of prior authorization.
- Submission of claims to the wrong insurance agencies.
- Incomplete or insufficient medical documentation.
- Incorrect patients’ demographic information.
- Invalid medical codes.
- Duplicate billing.
- Late submission of medical claims.
2. Assign The Right Work to the Right Specialist
As we all know that every medical specialty needs unique expertise and skills to deal with billing and coding tasks. A top medical billing company holds a highly trained and dedicated task force. That consists of certified medical coders and having a diverse range of experience in managing the various specialties.
So, after determining the leaks in your healthcare revenue cycle management, they assign the billing tasks to well-qualified professionals, who possess extensive industry experience in your specialty.
From insurance verification, medical coding claims submission, rigorously followed with the insurance companies, denial & accounts receivable (AR) management as well as payment posting process. Every task is handed over to the experts, which ultimately eliminates the billing errors and prevents the claim denials.
Moreover, reliable medical billing companies provide customized medical billing solutions that best meet your financial needs.
3. Avoid Coding Errors
As we have already discussed, a top medical billing company employs the AAPC-certified coders on their team. These experts ensure the accurate assigning of diagnostic, treatment and procedural medical codes as well as modifiers to describe the medical services a patient received.
They are well-versed with the CPT, HCPCS and ICD-10 codes. This enables them to avoid billing frauds such as upcoding, undercoding, unbundling etc. So, outsourced medical coders not only save your practice from financial loss but also from lawsuits i.e. heavy fines, federal penalties, imprisonments and cancellation of licences.
4. Ensure Submission of Clean Claims
Filing clean medical claims is the major component of streamlined revenue collections management. Because medical claims containing any one of the above-mentioned errors can result in denied, partial or delayed payments.
However, medical billing companies help physicians to achieve a 95% clean claims rate. For this purpose, they perform the claims scrubbing efficiently. During this process, they review the claims for the second time to set them free from potential errors that later cause claim denials.
In addition to this, they replace the orthodox methods of claims processing with automatic billing solutions. Which reduces the chances of human errors, and eventually increases the efficiency and accuracy of the medical claims. As a result, the claims get accepted on the first attempt and medical practitioners get paid faster.
5. Streamlines Revenue Cycle Management
Improved billing collections and consistent cash flow are some of the major benefits of hiring a top medical billing company. They fix all the inefficiencies that cause revenue leakage. Furthermore, it also enables medical practitioners to cut down the excessive costs associated with the in-house medical billing services.
Just think about financial peace of mind, you can get after getting rid of the investments in the deployment of billing professionals, training costs, state of the art office infrastructure, advanced billing software etc. You just need to pay a fixed amount and in return, the industry experts will take care of your financial well-being.
Hence, by reducing the excessive administrative expenses, filing clean medical claims in a timely manner and preventing future claim denials, outsourced medical billing specialists help healthcare practitioners to increase their revenue margins.
Is your medical practice struggling with a high rate of claim denials i.e. more than 10%? Then don’t worry and get in touch with Medcare MSO. It’s a top medical billing company in the United States. It has been providing reliable RCM services for more than a decade now. Visit our website to schedule a free demo of our services.