Higher Medical Claims Accuracy Saves Money

Over the past five to ten years, a number of developments and changes in the healthcare business have had an influence on reimbursement for medical practises. Third-party payers (UnitedHealth, BCBS, Humana, Anthem, Aetna, Cigna, etc.) have negotiated fee-for-service contracts with healthcare providers, frequently resulting in payments at less than 100% of charges as a result of Medicare and Medicaid's ongoing reductions in physician reimbursement. Additionally, the Health Insurance Portability and Accountability Act's (HIPPA) Administrative Simplification standards have tightened the guidelines for submitting claims data.

The government's focus on combating healthcare fraud and abuse, as well as compliance, have significantly heightened the importance of proper billing. Medical practises are being compelled to modernise their revenue cycle management procedures as a result of these worries.

What does Revenue Cycle Management entail?

The revenue cycle is described by the Healthcare Financial administration Association as "all clinical and administrative functions that contribute to the capture, management, and collection of patient service revenue." The revenue cycle is essentially everything that occurs from the time a patient account is formed (during intake, whether that's at a doctor's office, outpatient clinic, tertiary care centre, or another site) until payment for the specific treatment, operation, or care package. Depending on the nature of the patient's ailment, the diagnosis, the course of treatment, the use of medical codes, and the handling of claim denials, it could take weeks to months for a medical practise to get payment after submitting the claim.

The revenue cycle needs to be predictable in order to function at its best. That calls for the proper execution of its procedures, which is no easy feat. An early mistake might throw the whole thing off, leading to invoicing mistakes, tardy payments, and other undesirable outcomes. Regaining control may be time-consuming and expensive.

How severe is it?

Billing mistakes and a failure to stay up to date on medical billing standards and regulations cause U.S. healthcare providers to lose over $125 billion in uncollected income every year. The complexity of their operations and unique billing regulations provide even greater difficulties for specialists like radiologists.

Medical billing is, in fact, the foundation of healthcare revenue cycle management, yet many providers have considerable difficulties when it comes to correctly and effectively paying patients and payers for the services they deliver.

Because it involves several healthcare stakeholders and depends on past interactions, the medical billing process can be difficult for certain providers. Healthcare organisations must coordinate with other departments and payers and make sure that important data is accurately recorded at each stage of the procedure.

Unthankful Work?

Let's face it: overseeing your practice's medical billing and coding may seem like an unpleasant task, but the value of accuracy to the revenue cycle as a whole cannot be understated. Insurance companies determine whether the patient treatments are genuine and medically necessary based on the claims data produced by the healthcare administrative team.

It takes time and a very meticulous mind to follow up to make sure that claims are completely paid and any errors are fixed. Additionally, medical billing codes frequently change, which makes the procedure more difficult. Anyone in charge of making and submitting claims has to keep up with any recent developments in this area. Therefore, medical billers must ensure that they get precise information during the documentation process. Any one error made throughout this operation has the potential to result in a large loss of income and conflict with insurance payers. As a result, it could also have a bad effect on your company's image in the payer's community.

Because of this, skilled medical billing professionals should be quite knowledgeable about the precise diagnostic techniques, surgeries, symptom documentation, age, gender, pre-existing diseases, and other factors. They should be able to deal with the patient's private information in accordance with HIPAA rules in addition to filing claims.

Do you suffer from revenue losses?

A practise frequently loses the most money because to incorrect coding, which results in some claims being fully rejected and others just being partially reimbursed.

Unfortunately, a lot of healthcare payers use untrained claim examiners who make mistakes rather frequently. When employees gain "experience," many of them will continue to make the same expensive, recurring payment errors since their training frequently falls short of what is required to ensure accurate and efficient payments. According to a recent story in Washington Healthcare News, Paul Adams, Director, and Deanna Hodges, Manager, of the Seattle-based consulting business Moss Adams' Health Care Consulting Group.

Without an effective billing process in place, your practice is at risk for:

• incorrect claim coding
• inadequate account collection management
• Significant revenue loss that reduces your practice's profitability and puts your ability to compete and recruit top people in danger
• There's a significant likelihood that you've experienced income loss if you're lagging in these areas.

Consider a Reputable Medical Billing Company

The easiest method to guarantee a smooth revenue cycle may be to outsource the coding and billing to a reliable medical billing business. The coding and billing-related duties that are often not performed in-house owing to cost and time restrictions to care for patients can be efficiently managed by medical billing organisations with specialised staff.

With years of expertise in medical billing and credentialing, Medwave has assisted many healthcare providers in enhancing their revenue cycle. You may be confident that your credentialing, coding, and/or billing will be done to the greatest levels of quality when you engage with a professional billing organisation. This offers a significant portion of a reliable medical income source. Discover the ideal answers for a whole range of healthcare revenue cycle management.