In an industry where services can range from a simple wart removal to intensive liposuction, insurance carriers change the rules of the game annually, and the importance of proper billing procedures cannot be understated.
The Payment Request
Charge Entry
The first—and arguably the most important—step in this process is entering the charge into your system. With such an intricately-designed system as medical coding, the consequences of even the slightest errors can have major setbacks (more on that here). An up-to-date knowledge of medical coding is paramount, as CPT Codes are updated on a yearly basis.
Based on the type of treatment provided, you can reasonably estimate the requisite costs and forward it to the insurance company. This preemptive approach can alleviate uncertainty regarding policyholder approval for a procedure, which leads to a smooth cash flow.
Clean Claims
Any inaccuracies or missing data found in a claim can easily lead to denials, bringing the process to an abrupt halt. Scrubbing claims ensures that transactions don’t get hung up on such basic issues. A thorough review will allow for revisions and updates as needed before shipping off the fully-realized claim to the corresponding policyholder.
Delivering the Bill
Patient Billing
It’s always best to clearly state billing at the forefront of the process. Failure to sort payments while the process is still fresh in the patient’s mind can create problems during any follow up in the billing process.
Denials Management
Denials can crop up from any number of sources ranging from patient slip-ups to incorrect coding. Managing denials can be boiled down to a few key points: prevention, speedy resolution, and cash flow upkeep.
If you focus on accuracy in the billing process, you can decrease your chances of running into denials. Acquiring all relevant client information from the beginning allows you to address any unexpected hangups early. However, issues can still crop up from the other parties. Whatever the cause, dedicate available resources to working out a solution, which will cut down on the interruption to your profits.
Payment Collection
Pre-Collection
Once the billing has been issued, the ball falls into the client’s court. It’s on them to make the required payment, but this doesn’t mean your job is done.
Not all clients are forthcoming with their debts. When the final collection date rolls around, all unpaid debts are passed off to an agency that collects overdue payments. However, this impersonal handling can sour patient relationships if they feel you didn’t do enough to warn them beforehand.
This is why pre-collection letters are valuable. These are sent out prior to the final collection date as a reminder about unresolved payments. This can speed up the collections process and demonstrates good faith on your part by assuming the missed payment was unintentional, or for another reason.
Payment Processing
It’s rare to find clients who are willing and able to make cash payments for medical procedures. Quick and focused payment processing is a priority for any business. Be sure to provide your patients with a variety of options for making these transactions, whether over the phone, through the mail, or online. Convenience is key.
If you are considering these factors, you’ll be well on your way to a smooth and consistent cash flow for your business. Of course, you don’t have to go at it alone. The Auctus Group’s 97% clean claims rate means you’ll be free from the worry of a misplaced CPT code or unfilled data point affecting your bottom line.
