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How Efficient Are Your Medical Billing Processes in New ICD-10 World?

October 6, 2015

ICD-10_more_money-1When it comes to increasing your profit margins at your healthcare practice, this will undoubtedly lead to the ability to provide better patient care. As the facility owner, your passion is likely focused on using advanced treatments for today’s many health conditions. With an increase in your profit margins, providing the latest treatments becomes possible. To keep your profit margins as high as possible, it is imperative that you look at the efficiency of your medical billing processes. After all, these processes will directly effect your cash flow. 

Are you learning from denials?

If something doesn’t work, the obvious thing to do is fix it. The Medical Group Management Association says today’s better-performing healthcare practices have a claims denial rate of less than five percent. If you have a rate that is higher than this, you must ask yourself why this is happening. Generally, most denied claims come from ineffective coding, such as insufficient documentation. Fortunately, though, these types of problems can be eliminated with the use of software that gives red flags for errors and omissions before they go out the door. This type of professional coding will lead to far fewer denials, and better yet, better patient care because their treatments can be paid for as necessary, which leads to more cash flow on your end; this in itself can result in expanding your practice and services.

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Are you communicating with your patients?

When it comes to communicating with your patients, this involves every staff member they come into contact with. The better each staff member gets to know each patient, the better the whole patient can be treated. From nurses to the front desk receptionist, all medical personnel should be aware of the services covered by a patient’s insurance plan; this increases the number of insurance claims that go through without being denied. The best way to communicate with your patients is by being honest with them about your policies. Once you show them what you can do for them, they are likely to take advantage of at least one service or more.

Are you prepared to file appeals?

Not every claim is going to go through the first time around; however, you should have a competent billing code specialist who can properly assess whether or not the claim is worth appealing. It’s pertinent to keep in mind that with proper documentation, most appeals are easily won. More important to remember is that the results of your appeals are usually worth investing in.

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Do your coders have proper training?

Regardless of the training your coders had when you first brought them on board, they will need additional training on an ongoing basis. As the employer, you should keep up with this training to ensure compliance and requirements are being met. Not only will inefficient training in coding produce a higher number of denials, but it will also lead to poor services because patients won’t be having their needs met on a timely basis.

Are you ready for ICD-10?

There is a number of coding changes taking place with ICD-10, and while some healthcare facilities have already made the switch, if you haven’t, then you definitely need to be creating an action plan. The requirements that have to be met with ICD-10 are somewhat complex for many healthcare offices to maintain. The rules found in ICD-9 were created many decades ago in the 1970s. These newer rules are based on today’s modern research, allowing them to better diagnose illnesses and other healthcare conditions.


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