Medical Claims: Improve your Billing Process

According to a recent study by the American Medical Billing Association, close to half of all medical claims are left unsettled or denied because of common, avoidable issues. Duplicate claims, missing information, incorrect information and missing or incorrect codes can all slow down the claims process and can lead to claim denial – costing practices thousands of dollars.

McGladrey, a middle market tax, accounting, and consulting firm, has found what it touts as “the best kept secret to improve medical billing”. In a recent article, McGladrey found that in the same study done by the American Medical Billing Association, “24 percent of pended medical claims were pending due to other routine questions around coverage issues including no coverage based on date of service, non-covered or non-network benefits or services, coordination of benefits, or coverage determination.”

So, what does this mean for small practices that may not have the capability to double-check billing statements before they are sent out? McGladrey positions the receptionist at the “launch of a practice’s revenue cycle”, as their duties include intake information such as client’s general information & insurance, both of which must be correct when submitting medical claims.

In many small practices, this can be just the case. The front desk handles intake, but also practices management and billing from the same desk. This can be an overwhelming workload for someone who has likely not been trained in billing processes. With the impending ICD-10 transition, billing is about to become even more complicated. A busy receptionist may not have the time or attention to detail necessary to ensure all medical claims are being filed 100% free of errors.

The key to a smoothly working front desk and billing team is to empower and support those doing your billing with both training and assistance. Larger practices can hire an office manager or even a part time biller to help with these processes, assisting the receptionist and ensuring all necessary information is collected correctly for new patients. However, a small practice may not have the ability to hire a full time office manager or in-house billing professional. An alternative option is hiring a professional billing consultant. Professional billing consultants offer a fresh set of eyes to your billing process and are trained in the most recent medical billing practices. A billing consultant can assure that claims are being submitted with the correct information and codes necessary to receive payment in a timely manner.

As medical billing becomes more complicated, the need for professional billers will increase in practices of all sizes. Whether you are a part of a small physician cooperative or a larger organization, the impending ICD-10 implementation will complicate all levels of billing. To learn more about the changes to expect and how to prepare, read our blog on the new ICD-10 implementation. If you are interested in having a billing consultant to aid in your process, visit our services page. There you will find more details about the services offered by Billing Advantage.