Medical Billing: How Hospitals and Clinics Can Ensure Timely and Complete Reimbursements
Strange as it may seem, there is perhaps no business operation more critical to the continued existence of medical practices than billing. It is vital for health care providers to maintain a revenue cycle that is healthy to enable them to sustain consistent health care delivery, the process of which can be quite costly. However, despite best intentions, it is always not very easy to make sure that the practice gets paid for the rendered medical services quickly and in full. The problem is all the more since the provider of the health care is reimbursed by third parties well after the patient has been treated.
Not only is there a considerable delay between the service being provided and the payment being received but also there is always a chance that the insurance company may reject or deny the claim for a number of valid reasons. Some very effective ways of ensuring that your practice receives payments that are timely and in full:
Make Meticulous Claims:
The need to submit claims that are accurate and complete in all respects cannot be over-emphasized. Insurance companies are extremely finicky about the details and even the smallest of errors in information regarding the patient, the treatment, and the insurance policy can lead to the claim being rejected or denied. The health care provider will then have no option but to review the claim documentation, rectify the errors, and resubmit the claim. The whole process can be extremely time-consuming, stressful and the payment can be delayed leading to a cash flow issue at the practice. It is also very important that the claim is submitted to the right payer, though often the complexities involved can make a proper decision quite difficult.
Submit Claims Regularly:
It can be difficult to believe that despite the critical importance of getting cash into the medical practice, there are many physicians and hospital administrators who are not regular about submitting claims. There is a tendency to not to process claims till a number of them have piled up. The best way is to have a disciplined approach and set aside a time every day to submit claims. The practice should also make it a point not to sit back and wait for the claim reimbursement but to regularly follow-up with the insurance companies till settlement in full. The advantage of regular contact with the insurance companies is that you can develop a relationship that will usually lead to having your claims being settled faster.
Include the Patient in Insurance Follow-Ups:
It is not as if you have to fight a lone battle with the insurance company after having treated the patient to the best of your abilities. It is usually more productive to include the patient in your communication with the insurance company, as they can apply more pressure on the insurance company and also serve to provide any clarifications that it might be seeking. Make it a point to know the contract clauses intimately and enforce the terms rigorously. When making telephonic calls to the insurance be sure to ask for a reference number and record it properly in the case documentation. If you do not happen to be making progress with the insurance company for reasons that you cannot figure out, you need to escalate the case to the supervisor for more effective resolution. Remember insurance companies benefit the most by not making claim settlements so always be prepared to play hardball with them.
Outsource Your Billing:
If you find yourself not being to attend to your billing adequately, you should seriously consider appointing a reputed professional medical billing services agency. This ensures two benefits. Not only will you be able to streamline your billing and be able to get your settlements faster but you will also have the advantage of the clout that many of the more prominent companies have with the insurance companies.Even though you may have to pay a little more for their services, it is better to get yourself a company that is aggressive about delivering results and agrees to stricter performance benchmarks.
As a medical practitioner or a hospital administrator, you need to be on top of the game as far as billing is concerned so that you ensure the sustained viability of your practice. Set up a proper system of billing, ensure that you adhere to the set procedures, make sure that your documentation is correct, and follow-up aggressively with the insurance companies for faster settlement. If you are unable to devote the resources for this, the best solution lies in engaging a professional medical biller.