How Medical Billing Services Can Boost Healthcare Practices

Organizations in the healthcare sector require effective revenue cycle management in order to remain profitable due to its volatile nature. One of the ways to simplify the process for medical institutions is to outsource Medical Billing Services. It does not matter if you own a small clinic or a large practice, ensuring accuracy in billing is vital to be paid on time, avoid claim denials, and control operational costs.

Medical-Billing-Service

They include submission of claims, follow-up on claims, and even handle communications with the insurance company. The numerous codes and regulations pertaining to insurance and the various requirements set forth by the payers makes it necessary for there to be an effective system in place. One of the ways to achieve this is to collaborate with authoritative service providers such as Mava Care Medical Billing Company, which enables healthcare providers to concentrate on their core business operations, which is, providing quality care to patients.

In this blog, we will delve further into the importance of medical billing services, the process of medical billing outsourcing, and the advantages external medical billing services offer medical professionals in America. By the end, you will appreciate how external professional billing services can bolster the cash flow of your practice while minimizing time lost on administrative work.

The Importance of Medical Billing Services for Providers of Healthcare

In administering healthcare services, medical billing constitutes one of the most important management functions that ensures that healthcare providers are paid for the services they provide. If there are no proper billing systems in place, providers of healthcare services are more likely to face issues of late payments, unpaid claims, administrative bottlenecks, and errors that are detrimental to business health.

1. Having Claims Paid on Time and without Errors

One major reason as to why medical practices outsource billing services is to guarantee that claims are paid on time. Billing companies take care to ensure timely submission of claims in order to avoid potential rejections or even denial of the claims. Those who specialize in coding are less likely to require follow up, which automatically translates into prompt payment for services provided.

2. Preventive Measures Against Billing Mistakes

As the medical services evolve, so do the medical billing codes and requirements. To avoid mistakes in billing that result in extended payment periods or rejected claims, healthcare providers have to keep pace with rapid changes of codes. Following payment procedures helps to minimize the potential for making expensive mistakes. Medical billing services have experienced staff that understand specific codes and payment requirements, so the chances of these errors are greatly reduced.

3. Minimization of Claim Processing Denials and Rejections

Healthcare providers endure some type of claim denials and rejections. Incorrect claim submissions often lead to denial of the claim, which in turn causes delays in payment. Medical billing service companies usually have a system that filters claims for common errors prior to submission which minimizes denials and rejections. This system guarantees that claims are accepted in the first instance and reduces the time needed to turn around claim deficiencies.

4. Ensuring Improved Cash flow

Managing cash flow is critical to every practice. Practices that outsource medical billing, are able to lower their expenditures by ensuring timely payment while increasing revenue by minimizing the frequency of follow ups and eliminating delays in claims. More predictable revenue enables healthcare providers to better control their operational expenditure, which improves their business sustainability.

5. Increased Focus on Patient Care Quality

With medical billing services taking care of the administrative and financial parts of your practice, healthcare providers can maximize their focus on their primary goal, which is the wellbeing of the patients. Providers are able to direct a higher portion of their resources towards improving patient-centered care and the resultant health outcomes.

The Medical Billing Process: An Overview

The intricacies involved in the medical billing cycle demand meticulous attention to detail and encompasses stages such as confirming patient information, claim submissions, and payment collections. This section presents a supple overview of the medical billing process: 

1. Patient Registration 

Claim submissions begin with registering the patient. In this stage, healthcare practitioners collect pertinent personal details along with patient history, and insurance information. If honest and precise details are captured in this stage, the chances of erroneous claims being submitted during the billing cycle are significantly reduced. 

2. Insurance Verification 

No services can be rendered unless the patient’s insurance cover is first verified. This provides assurance that the patient’s policy is active and contains specifics such as services covered under it. Insurance verification also facilitates identification of co-pays, deductibles, or any other patient responsibility which need to be mentioned. These preventive measures assist in ensuring that amounts billed are accurate.

3. Medical Coding

Medical coding is central in the billing process. Healthcare providers need standard codes in respect of diagnoses, treatments, and procedures. This data is necessary for reimbursement purposes from the insurance company. These aspects of coding are current and require an understanding of constantly changing healthcare procedures. Coding is a technical field and coding people do require considerable amounts of training and need to be in touch with the latest changes. Out of date codes can lead to claims being denied or delayed. 

4. Claim Submission 

As in medical coding, a claim must be submitted to the proper insurance company guidelines to follow. Once done, billing submission can begin. A claim must be supported with proper payer codes so that the insurance company accepts it. Tracking, monitoring, and submission of claims can be vital in processing the claims in time.

5. Payment Posting 

Payment Posting is the step after the submission of claim payment for a service is received. After the claim is accepted and processed by the insurance company payment is posted in the account of the patient. At this stage, the billing amount is checked against the payment and the healthcare provider is paid the money. Any differences noted will be corrected.

Claim Follow-Ups That Remain Unsettled

The medical billing section must seek a resolution from the insurer to discuss any claims that they deem as resolved with payment differences. This includes analyzing what caused the denial, organizing any additional payment clarifications that must accompany the claim, and returning the claim seeking payment for processing. Following up on claims that have not been paid gives the practice a better chance of recovering money that is owed to them. 

Consumer Patient Billing

Lastly, when payment for a claim has been received from the insurance company, any outstanding balances are billed to the patient. Patients are notified on what is expected from them as far as payment (co-pay, deductibles on the claim, as well as other services that are not covered) so that payment is received. Moreover, consumer patient billing lets healthcare providers collect what is due to them for the services they have offered to a patient. 

The Problems Encountered in Medical Billing

As vital as medical billing is to the system, it remains a problem area for many if not most providers within the healthcare system. Below are some of the problems in medical billing that are frequent.

Refused claims: 

As illustrated earlier, claim refusals are a frequent issue in billing within the medical universe. A claim can be refused mostly because of improper coding, lack of information in the claim, as well as non-dischargeable requirements from the payer.

Billing Complexity: 

The medical billing process is multi-faceted involving coding, submitting claims, following up, and payment reconciliation. Such complexity increases the chances of errors that can cause delays in payments and significant administrative burdens. 

Changing Regulations: 

Medical billing working codes, requirements of the payer, and the regulations on insurances are perennially evolving. Keeping up with the updates takes resources to get this done. 

Insurance Delays: 

Insurance companies undeniably have long processing timelines. Payment delays stem from even the smallest mistakes in submitting claims. 

The magnitude of these challenges can be too much for providers of healthcare especially when small practices have few resources at hand. Medical billing is managed by many experts in the field enabling healthcare providers to concentrate on the patients instead. 

Why outsource medical billing services? 

The delegation of medical billing services can necessarily leave one billing expert dealing with just one client. But many experts now recommend the branching of medical billing. If executed properly, here’s how it can advantage providers of healthcare: 

1. Cost Benefits 

In a time constrained environment, outsourcing medical billing can remove the need for hiring an in-team and cover all expenses related to salaries, training, and infrastructure. Some practices complain about the payment delays or errors due-which cost extra money. These could easily be eliminated with the use of outsourced billing services.

2. Qualifications

Medical billing services are thoroughly versed with the intricacies involved in billing processes. They are updated with the changing industry standards, policies, payers’ needs, and everything necessary to ensure that the claims are made in an orderly and systematic manner.

3. Enhanced Effectiveness 

By transferring the functions to another organization, healthcare service providers are able to reduce the level of administrative work. This improves operational effectiveness and allows the practice to concentrate on the more important area – patient care.

4. More Timely Payment

Less errors, expert handling, fast claim filing, and enhanced payment cycles means that you can enjoy seamless cash flow owing to accurate billing.

5. Concentrate on Patients

With outsourced medical billing, you can put all your focus onto the patients. By having expert billing professionals handle these affairs, healthcare providers can put all their effort towards expanding their practice and enhancing patient care.

Conclusion:

At Mava Care Medical Billing Company, we provide a great range of medical billing services that will improve your revenue cycle and overall performance. For all the claims, our experienced billing specialists make certain that they are submitted, processed, paid, and denied quickly and accurately.

We comprehend the diverse issues being dealt with by healthcare providers and are prepared to make every effort possible to obtain deserved reimbursement for your practice. That is why with Mava Care Medical Billing Company, we guarantee you get the best care while we take care of the billing. Thus, you can fully dedicate yourself to your patients.