One of the biggest challenges faced by healthcare practices and crucial to their very survival is medical billing and collections. A healthy revenue cycle is important to sustain the process of making patients healthy. Unfortunately, physicians are trained to manage human health rather than revenue health and this is where the challenges arise. Healthcare facilities get paid for their rendered services long after these services have been performed; as generally these are paid for by third party payers. Add to this, rejected or denied claims, and you have a real problem on your hands.
There are certain factors that every healthcare facility has to look into to ensure that they receive complete payments for services provided and on time too. It is crucial that these factors are addressed and made a part of the regular process of billing and collections.
Incomplete data increases chances of rejections/denials
Payers are very particular about what they are paying for – and claims which are incomplete or coded wrongly are sure to be rejected or denied. Set checks and balances in place to ensure that the claim forms are submitted without any omissions or errors. Failure to do so will result in delayed payments as denials and rejections will need to be re-submitted with corrections made.
Ensure the medical claim reaches the correct payer
Healthcare facilities deal with multiple payers and health plans. It is very important to ensure that the claim is sent to the right payer – the one responsible for that particular payment. Claims sent to the incorrect payer will result in delays – the claim being denied and then having to be sent to the correct payer. Delayed payments do affect the revenue cycle nearly as much as denied payments.
Do not procrastinate in sending claims
Your patients want immediate relief from their ailments. Delayed payments are also ailments that a business suffers from – ensure that your facility does not suffer from this. There should be no procrastination in submitting claims for services rendered. However, care should be taken to ensure that the claims are complete and error free. Make it a habit of submitting claims at the end of the day for all services rendered during the day – this will ensure that all claims have been submitted and there are no backlogs to take care of.
Follow-up is as important as submitting claims
Do not sit back and relax just because the claim has been submitted – make sure that all claims are followed-up till they are fully paid. In the hustle of everyday work, it is very easy to miss out on the smaller claims. An established process of regular follow-ups will ensure that all services rendered have been paid for.
Get the patient on board
Involving the policy holder, through conference calls between the facility and the payer, often results in a positive outcome for rejected / denied claims. However, make sure that the rejection is not due to any omission or error in the submission.
Create a process flow chart and train staff to follow it
A flow chart makes it easy to execute a job as each required step can be checked against it. Create a flow chart for the billing and collection process. Make sure that each member of the staff involved is aware of the responsibility and requirements from them to ensure that the process flows smoothly. Establish regular training for the staff as well as for a few understudies to take up the responsibility in case of absenteeism of the regular staff.
Do not allow the contract terms to be violated
It is vital that you are aware of the contractual terms between your facility and the payer. Just as the payers ensure that incorrect claims are rejected or denied, it is important for the healthcare facility to ensure that the terms of the contract between them and the payer is not violated. Keep records of all conversations and correspondence between the facility and the payer. A contract is a legal commitment and the payer can be held to it.
Employ a reliable billing company
A medical billing company has to be on good terms with the payers – but at the same time has to have your back. We at MedConverge have always maintained very good terms with all payers and at the same time ensured that our client’s claims are always paid on time and in full. The track record of our RCM services speaks volumes about our competence and ability to deliver. With a dedicated team to take care of all your billing and collection work, MedConverge ensures that your revenue cycle stays in the pink of health.