Medical billing is an essential service that improves revenue cycle efficiency, which drives up revenue and drives down your lost opportunity cost . From inputting the registration to the final payment, here’s a breakdown of the process:

The Medical Billing Process

1: Pre-Submission

There are many things to consider before the billing process begins, starting with eligibility checks. A proper understanding of the patient’s insurance information is critical to determining payment.

Once that’s resolved, healthcare providers can accurately assess benefits. A comprehensive breakdown of deductibles, coverages and other factors in a client’s coverage impacts the billing procedure. At this point, the transaction is ready for authorization, which leads to coding. Consider taking the extra step and pre-collecting on benefit estimations so you don’t get stuck chasing that money down on the back end!

2: Coding

Medical coding is the core component of the medical billing process. Solid coding can increase payments. Over-aggressive coding can land you in hot water. Through diligent coding, staying up to date and focus on a specific industry, coding is probably the number one place your biller(s) can provide value (perhaps second to AR/Follow-up work…it can be a toss up though).

3: Charge Entry

Upon completion of the coding process, the appropriate charges are applied to the client’s medical account. At this point, the biller must ‘scrub’ it to ensure a smooth transaction with the client’s insurance carrier…you want that clean claim rate…no rejections for silly errors like missing data points. Once scrubbed, the claim can be submitted to the client’s insurance provider.

4: Payment Posting

After the initial submission, a review process verifies the accuracy of the data provided. Submissions are followed by record updates to make sure our pals at the insurance companies don’t “lose” anything or aren’t asking for something without actually asking…we’ve all seen these games…not our first rodeo. Once charges are verified, any payment denials from carriers are pushed to the AR Management process. This helps to avoid gaps in financial records. Additionally, payments are carefully reviewed for accuracy against contract or usual and customary for our out-of-network clients. Monitoring modifiers and impact on reimbursement therein as well as place of service is equally important. Just because you get paid doesn’t mean they paid you properly! We want to make sure you keep those insurance carriers honest.

5: A/R Management

Of course, a solid billing process won’t amount to anything if the insurance companies and patients don’t pay their bills. This is where accounts receivable becomes invaluable. The billing team will set deadlines for payment submission to ensure the clinic receives payment from the patient end. Leveraging multi-channel communication with patients to get bills to them in the fashion that elicits a response is huge. Us millennials can’t put our phones down so an e-statement or text works great there…whereas other demographics may prefer the old fashioned snail-mail method. It is all about diligence/consistency and the proper communication channel!

That said, claim denials don’t always stem from the patients. If a clearinghouse is involved, they can issue denials of their own, independent of either party. Accurate records can alleviate many of these issues, which is why the prior steps are essential to a clinic’s prosperity.

Insurance companies play games. It is just that simple. It is to their advantage to make getting payment difficult. Touch every claim, every month should be the pledge your biller makes. Now 100% compliance there is not necessary or possible typically (processing timelines for carriers sometimes extend 30-45 business days), but efficiency in process and diligence are imperative. Additionally…you just have to get aggressive at times. Call that corporate office. Escalate that claim. Don’t take the answers you receive if they don’t make sense. This isn’t the insurance company’s process…it is a business relationship between to private companies. You have every right to set your own rules and demand what is equitable.

6: Patient Collections

After addressing any issues in the payment process, all that remains is the final transaction. The medical billing team will reach out to the patient directly to ensure payment is on track and offer reminders until the bill has been resolved. Worst case scenario, you may need to involve a true collections agency and move towards credit reporting. This is a double edged sword. You gotta get paid! However, especially on the aesthetic end of the industry, reputation management is KEY. The balancing act between getting payment that you are due and avoiding patients taking advantage of the really unregulated ability to say whatever they want on the internet can be delicate. Just something to keep in mind.

Take Advantage of Worry-free Billing Services

The process behind medical billing goes beyond tallying costs and acquiring client checks. That’s why The Auctus Group offers these services for medical practices, especially those specializing in plastic surgery and dermatology.

With our 97 percent clean claims rate, we’re confident in our ability to provide you with worry-free billing services. Let us deal with billing while you focus on what matters—outstanding medical care.