Let’s face it – keeping track of all those medical billing rules from different payers can be tough. And it’s not just the sheer number. Insurers keep changing the rules of the game along the way.
Technology to the Rescue
Many medical practices improve their accounts receivables with software that includes (and automatically updates) all those medical billing rules. This kind of software can help you catch potential denials before you send in your claims. Remember when payers reject a claim the first time around, the likelihood the practice will ever receive payment drops significantly.
The Medical Group Management Association (MGMA) found that better-performing medical groups average just a 4.05% claims denial rate.
Is your practice’s denial rate above four percent? If so, it could be time for a checkup of your internal claims processing. Manual errors, input oversights and timing issues create more denials than many practices realize.
Keep an eye on the following common reasons for insurance denials to see if you can tighten up your billing approach and lower your denial rate:
Before most large medical practices find the best electronic health record system for their needs, they research many choices and find some discouraging up-front costs.
However, the transition doesn’t have to be as complicated, costly and painful as it seems. Many medium to large medical practices find web-based EHR systems the perfect solution for their clinical and operational needs.
Change may not always be easy, but for many practices outsourcing the more tedious medical billing and collections duties to experts can save time and boost profitability. Many times outsourcing also frees up your staff to focus on other important practice duties — including more patient engagement and interaction.
But how do you know if this strategy is right for your medical practice?
When I went for a recent annual checkup, my doctor came into the room carrying a tablet on top of a folder of paper records.
I asked about the paper files, and she said her medical practice keeps them and will rely on electronic health records going forward. This hybrid paper-past, digital-future approach didn’t seem very efficient. It also got me to wondering about the shelf life of paper or electronic medical records.
Sometimes a medical practice gets reimbursed too much money for services provided, which leads to an overpayment. The insurance carrier usually makes the overpayment, but sometimes patients pay too much for a particular service too. In either case, promptly return the overpayment to the appropriate person or payer.
If a patient pays more than required, notify them as soon as you discover the overpayment. A practice often can handle the overpayment in more than one way, but the provider cannot legally hold on to the money indefinitely.