Enable growth and reduce stress with consistent reimbursement. Make it happen with these tips:
Become knowledgeable in each patient’s insurance policy and contract
This is the most effective way to prevent denials. The provider manual released by the insurance company contains rules to ensure you are submitting clean claims.
Keep up to date on insurance guidelines, state regulations, and contract amendments from insurance
Insurance companies will make major changes to your existing contract through network/provider updates and amendments. These changes can be anything from CPT code billing guidelines to reduced reimbursement rates.
Connect your clinical department with your billing and administrative department
When the administrative team and clinical team work together there are less denials and less corrective claims, saving everyone time. Frequent communication will result in a more knowledgeable and productive team.
Analyze and Audit to prevent recoupments
Perform clinical audits
- Confirm all clinical documentation complies with audit requirements for each insurance company. Craft your medical record documentation to comply with the most stringent insurance company’s policies.
Perform billing audits regularly
- Validate all billing is complete in a timely manner with no duplications.
- Verify the correct rendering provider, procedure code, and modifier were billed according to the insurance company’s requirements.
Develop a revenue cycle schedule
Maintain a consistent schedule of revenue cycle tasks and assign staff specific responsibilities to ensure a healthy stream of reimbursement.
- Complete eligibility checks on every patient’s insurance policy
- Research each patient’s specific policy for benefit and coverage details or exclusions.
- Submit claims weekly
- Weekly claim submission ensures you are always filing timely claims and maintaining a consistent flow of revenue.
- Monitor authorization usage
- Careful scheduling and tracking of prior authorizations is imperative to ensure patients are maximizing, but not exceeding, their approved services.
- Develop an accounts receivable team
- An internal or external billing and accounts receivable team is crucial to avoid denials and resolve outstanding claim issues.
- Automate the payment process
- Enroll in electronic remittance advices (ERA) and electronic funds transfer (EFT). Electronic payments save time and cut down on paper waste.
- Utilize insurance portals for faster payment updates and claim status follow up.
Communicating with insurance about authorizations, claims, and contracts is time consuming and daunting. Managing all these moving parts while still providing exemplary service to your patients is a difficult balance to maintain. One way to reduce stress, reduce administrative costs, manage your time successfully, and maintain a healthy stream of revenue is to outsource as many of these processes as possible. Missing Piece provides contracting, authorization, eligibility, billing, accounts receivable, patient statements, and patient collection support.
Contact us today for your free revenue and billing analysis!