How to Improve the Medical Billing Process

Medical billing is the lifeblood of any healthcare facility or institution. It helps ensure all finance processes remain accurate and efficient. If there are errors or discrepancies in medical billing, doctors and support staff may not be paid on time, affecting all healthcare operations.  

Without medical billing, utilities would not work, and functional equipment would not be available for the institution’s everyday activities. This is why every organization needs to have an efficient billing process so their cash flow remains healthy. 

What is Medical Billing?

What is the medical billing process, and what exactly does it entail?

This is the process of gathering information and creating a bill for the services rendered to a patient. The bill is then submitted to the payer, who is responsible for paying the indicated amount. This can be done by a private-paying individual, but in most cases in the U.S., it is an insurance company. 

Some 304 million people in the country, which represents 92.1% of the population, are insured by private insurance or through the government’s Medicare and Medicaid system. 

An efficient medical billing process is necessary to ensure accuracy in billing. Mistakes could lead to delays in insurance refunds or, worse, rejection or denial. 

Implementing Advanced Strategies for Streamlined Billing

In the digital age, if you are still manually performing your medical billing process, you will surely be left behind. Medical insurance billing software has become necessary to ensure accurate and speedy processing. 

What are the 10 steps in the medical billing process?

1. The patient registers their personal and insurance information. 
2. The healthcare facility will look into the financial capability of the patient and their insurance coverage. 
3. The patient fills out medical forms that will be collated into a superbill, a document that contains all personal, insurance, and medical information. The superbill will also be useful if the patient returns to the facility for a follow-up checkup or another procedure. 
4. The facility prepares the superbill and generates claims for the insurance company. All claims are double-checked before submission.
5. The facility submits the insurance claims.
6. All parties monitor the status of the insurance claims. 
7. Insurance companies adjudicate or assess whether the claims have bearing and if a refund is in order. 
8. Insurance companies provide one of three rulings: an accepted claim when everything is in order, a rejected claim when there are errors, or a denied claim when the payer rules not to reimburse. 
9. The payer prepares the patient statement to indicate action on the claims. The statement includes the amount to be refunded and if there are outstanding charges that still need to be billed to the patient. 
10. Medical billers will send a follow-up if there are bills that have yet to be paid.

All of these steps will be simplified and streamlined with the right medical billing software like ClaimGenix.

Key Indicators to Measure Billing Process Effectiveness

How do you know if your medical billing process is satisfactory? Here are some key indicators:

Speed

How quickly did the facility get the amount from the insurer or private payer? Speed in getting paid is essential because it will fund the facility’s everyday operations. 

Accuracy is directly related to the speed of the refund. Errors delay the process as there will be more back-and-forth communication between the facility and insurer. 

First Pass Resolution Rate

How many claims are resolved upon first submission? Accuracy is critical and should always be the aim of every facility. 

High Gross Collection Rate

The medical billing process is considered effective when the gross collection rate is high, which indicates efficiency in the facility’s payment collection. 

All these key indicators can be improved, and you can have better success in medical billing claims through the use of medical billing software. 

How to Improve the Medical Billing Process

There are various ways to introduce medical billing improvements in the organization. Automation is one of the most crucial steps, and you need the right software to do so. 

Staff members must also meticulously review information at each step of the medical billing process. After all, the software cannot be expected to spot all possible errors in patient documentation and billing. 

Open communication is also critical. Instead of trying to guess information that the patient failed to enter, healthcare staff must make the effort to contact them. Accurate details are necessary in creating medical bills. 

The software will simply supplement the process for optimal performance. 

Conclusion

Medical billing is the reason why medical facilities continue to be operational and can serve patients well. The use of medical billing software like ClaimGenix will greatly improve facility operations. But it has to be complemented with capable administrative staff.