Skip to main content

Top 5 Medical Billing Strategies to Maximize Family Practice Revenue

May 1, 2018

Medical Billing Issues

Every year, medical providers in the United States leave more than $100 billion dollars of uncollected revenue on the table due to billing errors, coding mistakes, and failing to stay current on medical billing rules. Changes in the healthcare landscape have also left more patients having difficulty paying their medical bills, In fact, patients saw a 13% average increase in their out-of-pocket costs and deductibles just between 2014 and 2015.

Since family practices are facing a lot of factors that make it more difficult to get paid, it’s more important than ever to get proactive about billing procedures. Being proactive and prevent problems before they occur can help your family practice maximize revenue, ensuring you’re properly reimbursed so your practice can continue providing quality care to patients. Here’s a closer look at top 5 medical billing strategies you can use proactively to begin maximizing your family practice’s revenue. 

Strategy #1 – Make Sure You Have a Clear Collections Process in Place

One of the best proactive strategies you can use to maximize revenue is to make sure that you have a clear collections process in place for your practice. A step-by-step process that’s clearly laid out can help you ensure that patients are thoroughly and properly informed of their financial responsibilities. A good collections process should involve the following steps:

 Collect Information from Patients – Even before the first visit, it’s important to collect as much information as possible about the patient. This should include their phone number, place of work, home address, and email address. It’s also important to ask for a photo ID at the time of the visit. 

  • Have Clear Terms – Make sure you have clear terms of payment, informing patients of their responsibilities. Include paperwork that lays out their financial responsibility and takes time to remind them of their financial obligations. 
  • Regularly Verify Patient Information – Be sure patient information is up-to-date. At every visit, you should check with patients to see if their information has changed. 
  • Regularly Verify Eligibility – Check the patient’s insurance card and verify eligibility at every visit. This is one of the best ways to prevent claim denials. 
  • Lay Out Payment Options Available – Let patients know about payment options available, including whether you offer payment plans or whether you accept cash, checks, or credit cards. 
  • Collect Balances Due and Co-Pays Up Front – To avoid chasing down money later, collect patient balances due and co-pays up front. 

Strategy #2 – Properly Manage Claims  

With around 80% of medical bills containing errors and due to how strict payers can be about medical coding and billing practices, many claims get rejected. Going through the claims cycle of submission rejection, correcting errors, and then resubmitting can take weeks, which means your practice is waiting months before you finally get paid. Since editing and resubmitting claims wastes a lot of effort and time, it’s important to be proactive and make sure you’re properly managing claims. This involves double-checking medical claims before they’re submitted to prevent submitting errors. 

 Just a few of the most common errors that can result in denials include: 

 Submitting poor documentation, including incomplete, illegible, or incorrect documentation of a visit or procedure, making it tougher to verify and complete claims. 

  • Submitting incorrect patient information, such as insurance ID number, name, date of birth, etc. 
  • Sending in duplicate bills.
  • Submitting the wrong insurance information, such as address, policy number, or electronic payer ID. 
  • Mistakes in provider information, such as contact information, name, or address. 

 Double checking claims before they are submitted can help prevent denials. After claims are submitted, it’s a good idea to follow up with the insurance company to ensure you are up-to-date on any potential errors that may occur along the way. 

Strategy #3 – Work to Minimize the Occurrence of Coding Errors 

Medical coders use standardized codes within claims to make claims easy to process and decipher. These codes may use HCPCS Level II, CPT, and ICD-10-CM classification systems. Unfortunately, errors can still happen, including mismatched, missing, or incorrect codes. A few of the most common medical coding errors include: 

 Inputting too many or too few digits when using ICD-10-CM codes. 

  • Confusing different types of codes or inputting the incorrect codes for a claim. 
  • Mismatching treatment and diagnosis codes.
  • Using the incorrect modifiers. 

 Before claims are submitted, codes should be double-checked. If there’s any doubt about a code, cross-checking with medical coding resources to make sure you’re using the correct code can help prevent denials that cost time and money. 

Strategy #4 – Handle Rejected or Denied Claims Promptly 

It’s very important to know the difference between rejected and denied claims. Rejected claims haven’t been processed yet due to errors, and those errors keep the insurance company from paying the claim as written. A denied claim has been processed and is considered unpayable due to vital errors or a violation of the patient-payer contract. Claim rejections and claims denials are both returned to the biller and should include an explanation of the issue. While you can correct and resubmit rejected claims, denied claims have to be appealed before you resubmit, which is more time-consuming and costly for your practice. 

Related Article: 12 Tips to Increase Medical Practice Profitability

 Checking for errors proactively can reduce the occurrence of denials and rejections. If you do have a claims rejection or denial, it’s essential to handle it as fast as possible. Make sure you stay in touch with a payer’s representative so they can clarify any issues with the original claim and keep you up to date on claims while they’re processed. This can expedite your claim editing processes, reducing your appeal and re-submission times, which gets money in your pocket faster. 

Strategy #5 – Track Performance and Find Areas Where You Can Improve 

Since the healthcare landscape continues to change, your family practice needs to change along with it to improve efficiency and maximize revenue. One of the best strategies you can use to keep revenue flowing is to look for ways you can improve your billing procedures. This includes staying informed about changes to medical billing rules and changes in billing and coding protocols, identifying any problem accounts, and tracking pending accounts receivable to see how your family practice’s revenue cycle is performing. 

In some cases, one of the best things you can do to improve your practice’s billing and coding procedures to maximize revenue is to outsource your billing and coding. Billing and coding rules, standards, and procedures are constantly changing, and this can make it easy to miss small details that result in underpayments, denials, and rejections that cost your family practice both money and time. Outsourcing to a company like M-Scribe offers an effective way to regain control over billing and increase revenue. We offer dedicated specialists that are highly trained, we get claims submitted quickly, and this leaves your practice with the ability to spend more time focusing on your patients.  If you’re interested in outsourcing your medical billing and coding to improve revenue for your practice, contact us today at 770-666-0470 to learn how we can help you. 


Get the Latest RCM News Delivered

Receive practical tips on medical billing and breaking news on RCM in your inbox.

Get in Touch