How to Improve Your Medical Claims Process

Today’s medical billing process is often so complicated, that it’s commonplace for bills to take not just days but months to finalize when patients present with a complicated case or a significant medical history to take into account. 

With the challenges that come from coordinating internal practice workflow with all of the demands imposed by your claims processing vendors and external clearinghouses, the situation requires ongoing review, even for the most routine of care.

You should know that your organization has many options available to improve the coding and billing process, leading to faster submission times and a boost to your first-pass approval statistics.

Here are 8 ways to improve the medical claim billing process for your organization starting today.

1. Clarify the Collections Process Upfront

Open, transparent communication with patients is essential for more efficient medical claims billing efforts. Make sure that you communicate with new patients about their responsibility for paying for services provided. You can include the details in the paperwork patients fill out before their first visit. 

A sign posted in the reception area to clarify the payments system will also be useful, with patients not being able to claim they were ignorant about your policy. To support timely collections, obtain billing information from patients that day, including making a copy of their insurance card and a photo ID for your files.

2. Maintain and Update Patient Files

If you don’t have precise details on all of your patients, how can you expect to handle claims billing with accuracy? You’ll need to instruct staff to verify patient demographics as well as insurance information at each visit. Why is this necessary? For one, your patient may have changed jobs and now has different insurance provider, or has coverage from a new spouse. 

The nature of insurance may have changed too, with a patient possibly upgrading to the most expensive plan with lower deductibles, or to a less expensive plan that now requires much more out of pocket expenses. Instead of your patients being surprised by an unexpectedly higher bill, make a point of explaining the process as you update their details. Be sure to double-check such mundane details as the policy number and subscriber information (including the billing address for the health insurance company). It’s crucial that these details match up with third-party payers’ records.

3. Automate Basic Billing Functions

Forcing staff members to do tasks that are more easily accomplished by automated systems is a drag on your business. It drives down morale and frustrates employees who could otherwise be free to focus on more patient-centric, personalized service. Identify billing tasks that are routine and mind-numbingly repetitive. Tasks include filing individual claims, generating and then issuing payment reminders and assistance in selecting the right medical billing codes. 

4. Train for Success

Every insurance company that your organization deals with will have its own unique set of rules. One on hand, an insurance company may demand that you include chart notes with claims for new patients, to establish a primary care relationship. On the other hand, you’ll find insurers that ask for chart notes only to support follow-up care and non-standard treatment protocols. 

Update and expand your employee training programs to now include components that enable billing departments to quickly find the relevant filing requirements as well as to access patient files. This helps ensure that each carrier has the information necessary to expedite claims processing as soon as you submit them.

5. Track Denials

Whether a practice relies on an external medical billing and coding vendor or opts to process claims internally, it’s clear that having a system of checks and balances in place will improve first-pass rates. 

Instead of berating employees for mistakes, adopt the attitude that every rejection is actually a learning opportunity to improve the process. For example, when you see higher than expected denial rates, that could be a sign you need to give your team advanced training, or that your scrubbing process is insufficient for your current workflow.

Common reasons for denials include:

• Physicians are not properly credentialed
• You lack sufficient support documentation
• Your team uses codes for services or equipment that are not covered by carriers

When you track denial codes, you may see easy steps your practice can take to boost efficiency. For example, sending chart notes to the billing department along with billing codes daily could save significant time and improve accuracy. Likewise, if you find claims are consistently returned for services deemed to be “non-covered,” that could mean it’s time to review the process for verifying coverage as well as your coding protocols.

6. Outsource Your Most Problematic Collections

As a provider offering service in the community for many years now, you and your fellow stakeholders may be reluctant to consider outsourcing medical billing services. But it’s prudent to keep an open mind, especially when the efficiency of your revenue cycle is at stake. Working with a third party medical billing company frees up your staff, leaving the more challenging collections to experts. 

They will employ compassion and sensitivity while helping your patients come to terms with their outstanding bills, such as setting up a payment plan. Your staff will no longer bear the brunt of unhappy patients who are having problems paying their bills, and your cash flow should start to improve.

7. Enhance Quality Control

Eliminating claim errors is critical for the financial state of your practice, to be sure. However, the billing and collections process does not stop once a claim is approved. Using generally accepted accounting practices to post and record payments helps medical providers keep a close watch on the cash flow. 

You can improve account balance accuracy by creating a deposit log for each receipt, to be sent to the billing team. The log needs to include all information needed to ensure proper posting, as well as to make it easy for a reviewer to confirm correct payment amounts posted to the right accounts.

A log should include these basic details:

• Patient name
• Account number
• Check/Cash Receipt number
• Amount due
• Date of service or referral reference number

8. Follow Up on Delinquent Claims

How much money is waiting to be posted to your practice? Answering this question will show you the percentage of delinquent claims awaiting service. At least one dedicated staff member should be assigned to review account aging, to determine which claims are not being paid in a timely manner. 

After thoroughly reviewing aged accounts receivable, you may detect communication issues with insurance carriers or patients. Are the delinquencies caused by medical biller errors? Are your statements easy for patients to understand? Is the billing and medical coding vendor working your claims expeditiously?

High delinquency rates are a sign of a bigger problem. You can meet these problems early on when they’re easier to solve when you consistently review delinquent accounts with an eye to improving performance. It is important to implement processes and patterns that help your team file claims faster and more efficiently for revenue capture. It’s possible there are some communications issues between you and other stakeholders, so a meeting on the topic may be in order.

Ultimately, reviewing the medical billing cycle from the first patient contact through check deposit will enable you to improve the claims process and capture reimbursements more efficiently, thereby improving cash flow.