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6 Strategies to improve your medical billing and claim processes

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Although there are challenges that can arise during the claims process, such as denied claims and complex procedures, there are several solutions to help speed up the process and increase the accuracy of your medical billing and claims. Here are six strategies that you can start implementing to improve your medical billing and claims process:

1 ACCURATE AND COMPLETE PATIENT INFORMATION

It all starts with the patient. Getting accurate and complete information from all your patients is the first crucial step. This strategy already avoids a lot of simple, yet frequent, mistakes along the way. Ensure that staff are trained to check and validate demographic and medical aid information with every visit (this applies to new and existing patients). Why do this?

  • Patients can change from one medical aid provider or plan to another
  • Patients may opt to become dependants on their spouses’ medical aids
  • Patients can also move from one location or job to another.

Always double-check patients’ information and ensure that the information matches the records of third-party payers.

2 HIRE A BILLING EXPERT

Invest in your practice by hiring a billing expert who can assist you to monetise overlooked income opportunities. Choose a billing expert with advanced knowledge and experience of your speciality’s billing codes and rules to ensure accurate and optimal billing. By hiring a dedicated billing expert, you can rest assured that all billing and medical claims can be switched/sent out daily to ensure correct figures and a healthy cash flow.

As a result, billing experts can solve various issues that may arise during the medical billing and claims processes. They are medical billing professionals that know what medical codes to use, and they will provide quick, accurate and efficient billing and claims services.

Now you can devote all your energy to providing quality care to your patients.

3 AUTOMATE AND DIGITALISE   

In today’s day and age, using staff to do tasks that can be automated will be a drag on your medical practice. Opt for an automatic and digital approach that allows you and your staff to focus more on patient-centric and personalised care services.

How exactly can you do this? Invest in medical software that not only fits your practice’s requirements but one that offers automated functionalities. A great start is identifying billing and claiming tasks that frequently occur in your practice
that have become a mind-numbingly repetitive routine.

Examples of automated and digital systems can include the following:

  • Updating patient information through an integrated patient portal
  • Paperless filing – have all your patient information, clinical documents, communication, claims and accounts,
    for example, in one place
  • Setting up billing macros/combinations that consist of a set of medical codes that are always used for each specific treatment
  • Create multiple invoices simultaneously and send the batch to be claimed by their respective medical aids with one click
  • Sending mass communication to patients regarding their outstanding accounts with a click of a button.

By utilising technology, you get to avoid discrepancies due to poor penmanship or misplaced files.

4 IMPLEMENT TRAINING SESSIONS

Dealing with medical aids is no easy job. Each medical aid comes with its own set of rules and regulations when it comes to billing and claims. Implementing training sessions for your staff can be a wise move. Training that centre around billing and claims processing will have a ripple effect on each role in the practice. For example, if the receptionist understands the importance of accurate and complete patient information, they will understand that it plays a key role in the billing and claim processes, which may eliminate the risk of rejected claims due to inaccurate/incomplete patient information. Training will, therefore, ensure that each role in your medical practice has the information necessary to expedite claims processing.

5 DILIGENTLY FOLLOW UP WITH CLAIMS

Having a strict follow-up procedure in place is the cornerstone of good cash flow. When claims are denied due to error, your income will be delayed. The billing department should regularly be in contact with medical aids and patients to conduct follow-ups to keep track of all claims.

It is important to ensure that all claims are checked daily for the following reasons:

  • Maintain a steady and healthy cash flow
  • Reduce the amount of time that accounts remain outstanding
  • Ensure that all claims are submitted to the medical aids before they become stale
  • Reverse, redo and resubmit erroneous claims in a timely manner
  • Move any outstanding or rejected claims to the patient liable portion of the account so that patients get notified to pay any outstanding amounts.

After claims have been approved by medical aids, the billing expert still needs to make sure that they are actually paid, and accurate receipts are processed. Electronic remittance advices (ERAs) save lots of time and prevent erroneous linking of receipts to invoices. All payments must be correctly allocated to invoices so that reporting can indicate which unpaid claims need to be followed up.

6 RECORD KEEPING

 Record keeping is an important part of accounting best practices and keeping an updated log of each patient’s bills, claims and receipts can be managed in software. Logs will assist bookkeepers and auditors to verify financial records.

Logs should include the following information:

  • The patient’s full name
  • The patient’s account number at the medical practice
  • The receipt number
  • Date of service and/or referral reference number.

CONCLUSION

 An electronic medical billing system is of paramount importance to achieve an efficient, patient-centred, and financially stable medical practice. Implementing the strategies will be well worth the effort and investment.

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