The hospital medical billing process is challenging and time-consuming. It involves several components and processes; understanding them is necessary to ensure a smooth revenue cycle.
Demystifying Hospital Medical Billing: Essential Terms and Concepts
Hospital medical billing follows basic standards, which set it apart from other types of billing. To clear up the confusion, here are must-know facts about hospital medical billing:
Medical billing comes in two forms: institutional/hospital billing and professional/physician billing.
- Hospital billing refers to the billing of inpatient and outpatient services, services provided by skilled nurses, and the use of laboratory services, medical supplies, and equipment.
- Professional billing refers to the billing of medical services provided by physicians to insured patients. It includes billing suppliers and non-institutional providers for outpatient and inpatient services.
Billing and coding are different processes. The terms billing and coding are often mentioned together, but they are distinct processes and play different roles in filing claims.
- Medical coding involves identifying billable data from clinical documents and medical records. Coders assign specific codes as per the description of a patient’s condition and treatments received.
- Medical billing uses those codes to file insurance claims and bill patients to obtain payments for the services of a healthcare provider.
There are three types of medical systems for billing:
- Closed – a system that is not allowed to make transfers and is represented by only one practice (e.g., EMR or Electronic Medical Records)
- Open – a system that allows transfers between professionals, practices, and other healthcare facilities (e.g., EHR or Electronic Health Records)
- Isolated – a system maintained solely by patients that is not legally accepted. (e.g., PHR or Personal Health Records)
The Importance of Accurate Medical Billing
Medical billing is the livelihood of any healthcare organization. It requires basic knowledge of medicine and a proper understanding of medical terminology, without which billers could submit claims with wrong patient information or inaccurate codes. The resulting under- or over-payments may cause legal issues and financially impact your organization.
Accurate hospital medical billing and coding ensure the following:
- Accurate reimbursement – with billing experts and quality protocols, you ensure there is no oversight and errors that could result in claim denials and delayed reimbursements.
- Standardized documentation – uniform documentation helps streamline workflows, enables accurate billing, and prevents claim denials.
- Improved patient safety – accurate medical codes help assess patient health, improve the quality of healthcare, and influence public policies.
Maximizing Your Hospital Medical Billing Reimbursements
Here are ways to become more proactive in the medical billing process and optimize your hospital’s revenue:
- Manage claims properly – since resubmitting claims involves wasted resources, claims must be complete and accurate the first time. Accuracy and completion involve inputting the correct information and codes and double-checking them for any possible error.
- Minimize errors – coders describe a patient’s procedures through standardized codes, such as ICD-10-CM, CPT, and HCPCS Level II classification systems. Examples of common errors are missing, incorrect, or mismatched codes, which may lead to upcoding and undercoding, resulting in denied claims.
- In addition to hiring expert coders, you may use claims scrubber software that verifies that all codes in a medical claim are accurate.
- Handle denied or rejected claims promptly – act quickly and follow a validated process to correct denials. Track claims as they enter and leave the system so denials are corrected and resubmitted to prevent revenue loss.
- Learn ways to improve your system – analyzing rejected claims and denial trends makes it easier to identify where problems occur and find the solutions to fix them, helping to expedite the claim submission process.
- In addition, you maintain accuracy and efficiency by staying up to date with the changes in coding regulations. Stay on top of these changes by regularly seeking training, which is less costly than repeatedly receiving denied claims.
Tips for Avoiding Claim Denials
Here is a list of the best practices to proactively avoid claim denials:
- Collect complete and accurate patient information – just one blank field or wrong data entry could result in a denial.
- Examples of important information you should double-check are the patient’s name, date of birth, policy number, and insurance payer.
- Leverage technology – automating tasks streamlines your workflows and speeds up the process of collecting and retrieving information. Invest in practice management (PM) and/or electronic health record (EHR) systems. These tools prevent important data from getting lost in translation, ensuring more efficiency and accuracy.
- Verify referral and authorizations – taking time to learn which services require referrals and prior authorization means mitigating eligibility and pre-certification issues.
- Stay on top of changes – it is not enough that your software flags billing inaccuracies. Your staff must always be updated on the changing landscape of Medicare standards and other payors. Attend conferences and subscribe to newsletters to remain aware of the latest changes in billing and coding rules and regulations.
- Learn from previous denials – investigating the causes of denials allows you to learn where problems occurred and determine the best solutions to fix and avoid them.
- Meet deadlines – missing deadlines established by insurers affects claim filing.
- Conduct performance audits – audits uncover weak links in your system and allow you to find the best solutions to improve your workflow and billing process.
How Outsourcing Your Hospital Medical Billing Can Increase Your Bottom Line
Not every organization has the manpower, talent, and IT resources to keep pace with the rapidly changing healthcare landscape. Finding a billing partner may be the best solution to reengineer your revenue cycle management and increase your cash flow.
Here are four ways outsourcing hospital medical billing services increase your revenue:
- Saves time and money – calling patients, relying on paper billing, and training your staff could be costly and a waste of time. Eliminating these tasks lightens your employees’ workload and reduces the need for hiring and training new staff.
- Streamlines your billing process – your medical partner integrates the most advanced hospital medical billing software into your current office system. Data becomes standardized and accessible from anywhere in your organization, increasing the efficiency of your billing process.
- Reduces overhead costs – cutting down on expenses is a great way to boost your bottom line. With in-house billing, you spend on wages, employee benefits, licensing of software, clearinghouse, printing, and postage fees. By eliminating these costs, you ensure a healthier revenue stream.
- Increases accuracy of your billing procedures – outsourcing your billing means working with experts who specialize in hospital medical billing. They are trained in proper coding techniques and are constantly updated on the changing rules and regulations. Their knowledge and experience lower the risk of errors and denied claims, helping to increase your net collections.