Healthcare reimbursement is not a one-step process; there are a thousand things that need to be taken care of before you jump to the next step. From managing and registering patients to submitting the claims and getting reimbursed, it can be a lot to tackle at once. The process is so lengthy and complicated that sometimes it takes months for patients to get reimbursed. This is where Medical Billing Services enters the process as your guardian angel.
What does a medical billing company do? Companies like Unify Healthcare Services help you focus better on core tasks as we have professionals ready to deliver their best work every step of the way. Cost savings, revenue maximization, and enhanced patient satisfaction are just some of the perks of outsourcing your medical reimbursement services. Still, it doesn’t seem like a lot of work, right? Let me explain how exactly medical reimbursement services works.
Gathering Patient Information
The most important piece of the puzzle is collecting the required information from the patient efficiently. Inaccurate information can lead to blunders in the claim submissions and rejection of claims altogether. The information provided by patients is what we call the electronic health record (EHR); all this data combined forms a patient's medical record.
Information here includes patient demographics, such as name, age, gender, address, and contact information; treatment plans and progress notes; and clinical data like lab test results, dental records, blood pressure, etc.
Medical Codes
Medical codes are assigned to the electronic health record provided by the patient by professional medical coders. Specific medical codes are given to every EHR so that the documentation can be converted into brief terms for payers to interpret what services are being provided by the healthcare professionals and why they are being provided.
The most used medical codes are the International Classification of Diseases (ICD) - 10 codes, which describe what the diagnoses are, and Current Procedural Terminology (CPT) codes, which show the procedures and services undertaken by the patients. The provider receives these codes from healthcare professionals and puts them in the software for further use.
Submission of the Claim
The claims can be sent directly to the payers electronically. If the provider has made a mistake, the claim submission is returned through a clearinghouse. After correcting the mistake, a clean claim can be submitted again. The steps to successfully submit the claim are:
- Gather required documents.
- Access the Insurance Portal.
- Fill Out the Claim Form.
- Attach the Supporting Documents.
- Claim Scrubbing
- Submission of the Claim
Payer's Response
There are different types of payers, like government payers (Medicare, Medicaid, and CHIP), commercial payers (United Health, Aetna, and Humana), and private payers (Blue Cross). The claims are reviewed by the payer after going through the clearinghouse; if there are no mistakes, the reimbursement is processed without a delay, and if a mistake is found, then the claim submission is sent back for corrections. Usually, the reasons behind claim rejections are non-coverage by the plan, inaccurate documentation, lack of medical necessity, etc.
Post Payment Audits
After the claim has gone through, the payers ask for documents to ensure that the information submitted before was accurate and not fabricated. If any malpractice is found, then the payments have to be returned to the payers. Post-payment audits are conducted to prevent outdated or incorrect coding, to identify under- or over-coding, and to ensure compliance. These audits are beneficial as they can help identify and recover millions in overpayments.
The healthcare reimbursement system is a multi-step process, as seen above. It takes a village to go through each step with keen attention to details so that there is no room for errors. But wait, this was not the complete story, as several tiny details come under every step.
So how is it possible for a healthcare professional to manage healthcare reimbursements and their medical practices while also boosting the revenue, all at the same time? Instead of burdening your staff with these complex tasks, you can always trust professionals to take care of it for you.
How Would a Professional Medical Reimbursement Service Boost Your Revenue?
Medical billing companies like Unify Healthcare Services are equipped with the technology and manpower to boost and update your revenue cycle management strategy. A weak RCM strategy can be the reason behind the delay in payments and can have a negative impact on your earnings.
A medical billing company uses AI and automation and a professionally trained staff to work on your weak spots and improve precision, strength, and effectiveness. By the end of this blog, you will have a comprehensive understanding of how exactly partnering with a medical billing service company can help you maximize your revenue and streamline the process of healthcare billing. Let’s look at some expert strategies that could help you boost your earnings.
Accuracy in Patient Registration
There are three very important things when it comes to patient registration: contact details, payments, and insurance details. With a lot of patients coming in every day, it can be difficult to manage the administrative burden that comes with it. By outsourcing this to a trained staff of professionals, the margin of error can be reduced by a lot, which could result in you grabbing that extra dollar.
Automation in Scheduling
Enhanced patient satisfaction is the key to unlocking success everywhere, and to do that, the arrangement has to be user-friendly on every level. Automation makes it easier for patients to schedule an appointment at their leisure and guarantees long-term loyalty from the customer to you. It significantly reduces manual data entry and hence manual labor in general.
Some of the key aspects of automation in scheduling are data extraction and validation, medical coding automation, insurance eligibility checks, claim scrubbing and editing, and payment posting and reconciliation.
Using Data to Understand the Trends
Data analysis is a must in every industry these days; it gives you an edge in providing the best possible customer experience. Patient preferences are what makes or breaks a deal, so with the help of data that has been collected through texts, emails, and calls, you can learn how to deliver information about scheduling appointments and reminders for payments. Through data analytics, you can keep track of the recent claim denials and make sure there are not any recurring errors. It can also help you track how efficiently you are collecting payments for the services rendered.
Powerful Follow-Up System
A robust approach to following up on unpaid claims and patient balances is a must, as it ensures that you are not careless with your process and are well-equipped to handle any situation that would be presented in front of you. There must be a clear timeline for every stage of the process. Another thing that needs to be analyzed in short intervals is your accounts receivable so that if there are any recurring issues, they can be solved as soon as possible.
Trained Professionals
It is a very time-consuming process to train your staff from the very beginning of everything when the industry demands everyone to be on their best game. When it comes to medical coding, one small error can result in claim denial, which would discredit your business altogether. So, to perform exceptionally, you need to hire trained professionals or outsource to someone who has the correct people to work towards achieving excellence.
Cost Savings
Outsourcing can save you the cost of training your employees or hiring new employees with an increase in expenses because of salaries and benefits. An in-house billing team can incur various expenses that are unnecessary and result in an administrative burden. Outsourcing can save you money by deducting the cost of buying medical software or any other computer equipment.
Conclusion
In conclusion, in today’s fast-paced world, if you don’t keep up with the industry standards, then it doesn’t take much to be left behind. Be it any industry, adaptability is the key to success, specifically when it comes to medical billing services. Leveraging technology to enhance your revenue is a must. There are multiple ways of boosting your revenue with professional medical reimbursement services, from cost-saving to using data to analyze user trends. Healthcare reimbursements are being outsourced all over the world, and medical billing services in New York and various other prominent cities are being utilized by healthcare professionals to ease their burden and not lose any money at the same time. Efficient medical billing services are the backbone of a thriving healthcare system, taking care of both the providers and the patients. We at Unify Healthcare Services believe in making your life easier by going that extra mile for you. So, take a step towards the future of healthcare reimbursements, and let us help you on this journey.
