How to Maximize your Medical Billing Reimbursement

Now more than ever, maximizing medical billing reimbursement is critical for hospitals, private practices, and medical facilities. With COVID-19 cases still lingering, the widespread medical professional shortage due to the Great Resignation, and the No Surprises Act changing the landscape of patient care, medical billing professionals need to stay current and agile in making sure they are collecting every dollar owed. 

Are you collecting every dollar owed? The best way to answer this question is by reviewing historical data (over the past 12 months or so) to determine your net collection rate, but this is very time-consuming and expensive – and pulls your professionals away from critical everyday work. 

So let’s discuss some shortcuts that can help you maximize medical billing reimbursement for your practice. 

Generally, after conducting an analysis, our AdvantEdge professionals determine that billing operations fall into one of these three categories:

• Only slight tweaks are needed: Providers have well-defined and executed processes and aren’t missing a significant amount of money.
• Process improvements are needed: Providers may have processes, but professionals are sloppy at execution or have too much turnover or lack skilled staff and are missing at least 5 percent, 10 percent, or 15 percent of their collections potential. 
• Major new processes are needed: Providers don’t have well-defined processes, don’t follow them, or never have quite enough skilled staff, resulting in them leaving a lot of money on the table.

The Definition and Importance of Well-defined Processes

When we talk about a “well-defined process,” we mean that a company has the major elements of an RCM cycle in place such as

• intelligent medical billing professionals.
• front-end procedures.
• scheduling.
• patient education.
• deductible and co-pay collections.
• coding and claims filing.
• etc.

 For providers in the first category, which unfortunately reflect only a small percentage of how many traditional providers have operated in the past, only minor fine-tuning needs to be made to one or certain areas within their processes. 

It’s important that employees not think of their position in a silo (nursing, scheduling, billing), but instead as a functional group. By interacting and communicating as a group, this enables team members to see the big picture and how each person fits in, which ultimately will solve billing inefficiencies. 

Prioritize Your Processes

Maximizing medical billing reimbursement should reflect strong attention and dedication to maintaining and promoting these well-defined processes. Have a “this is how we do things around here” so that staff members understand and continually follow best practices. With that said, it’s also important to be open to improvements to the process. 

For example, consider the process of a traditional private practice scheduling appointments. Historically, the process has been calling to book and remind patients of their upcoming appointments. However, the employee that handles scheduling has noticed their demographic includes a younger generation of patients that don’t like to talk on the phone, and only interact digitally. By voicing a tweak to create automated text or email notifications requiring a response, the practice could see a higher engagement and confirmation of appointment date/time. 

This is a very simple example, but it indicates the attention to process while having the flexibility to make changes that ultimately benefits the practice and its collections. 

Do you believe your company might fall into the second or third category? If so, we suggest you download our free eBook, “Are We Really Collecting Every Dollar We Are Entitled To?,” that provides insight into how to revive your processes so that you can achieve the top category. 

To learn more about maximizing medical billing reimbursement, we invite you to get in touch with an AdvantEdge expert now, or stay up to date on company and industry trends by visiting our LinkedIn page.