The entire medical billing and coding process is complicated and involves many different layers of operations at the same time. From insurance eligibility verification to collections, it consists of hundreds of tiny steps that lead to the final claims payment decision: approved or denied.
It is important to understand the entire medical billing and coding process, even if other people will ultimately be responsible for the day-to-day management of it. By taking complete ownership of this part of the business, healthcare providers can ensure that claims submissions are timely so that medical billing is at its most effective.
Understanding the bigger picture can help you remove inefficiencies and redundancies: Working knowledge of the entire medical billing and coding process is also useful for when healthcare providers want to incorporate more efficient workflows or enhance their current operations in some way. This is because redundant tasks or unnecessary steps in the process can lead to a wastage of valuable resources and increase the costs that a healthcare facility has to deal with on a daily basis. By eliminating these tasks and finding better ways to carry out the same process, a healthcare provider can gain in operational efficiencies and reduced processing times per claim.
Medical billing begins with insurance eligibility verification and collecting the necessary deductibles or co-payments. Coding then comes into play to ensure that all the medical services that have been provided by the practice have been accounted for and recorded. The appropriate modifiers are then added to further describe the treatment that was provided. The coded claims are then uploaded into practice management software, sent to a clearinghouse, and submitted to the insurer. The carrier then either accepts the claim for payment or rejects it.
When you understand the bigger picture you recognize that payments need to be collected in the shortest period of time: The final payments are received, and the balances are then transferred to either the patient or a secondary carrier. The payments that are made can either be partial or unpaid entirely. The objective of claims submissions and AR management at this point is to ensure that the shortest collection period is always met. Time is of the essence so minimizing the outstanding AR days is imperative to getting cash flow back into the business.
Medical practitioners need to understand the big picture. What that means is that they need to know that the best way to stay profitable as a healthcare provider is to minimize the amount of time that goes by before payment is collected. The more time that goes by, the less likely it is that the insurance carrier or patient will make a payment.
When you understand the bigger picture you won’t get lost in all the details: All this is to say that looking at the stats or numbers, like the total number of claims denied, will not help the medical practice regain lost revenue. What will be useful to streamlining the medical billing process and making up for lost revenue is knowing what to focus on long term. If time is the most important factor in recovering lost revenue and appealing denied claims, that is where the entire medical practice should redirect their focus.
There are literally several ways to improve the medical billing and coding process at any medical practice. But there are only a few ways to truly streamline the process to bring in lost revenue and avoid non-payment from both patients and insurance carriers alike. By understanding the bigger picture, healthcare providers can make their medical billing process more concise and streamlined. This is because knowing where to focus your attention and resources is more than half the battle when it comes to making the medical billing process most effective.
Warren James is the lead editor for Diving Daily. Warren has written for many publications including the New York Daily News, Vanity Fair and Yahoo. Warren is based in New York city and covers issues affecting local communities. In addition to following the day-to-day life of the Big Apple, Warren also has a passion for martial arts.