5 Medical Billing Mistakes To Avoid For More Profits?

Medical billing is the most crucial part of the healthcare system and requires expertise to handle. While there can be multiple mistakes which can occur while handling the process, this article focuses on the top 5 mistakes to avoid for more  profits. 

1. Unorganized Documentation: The medical billing process incorporates various steps, including scheduling  patient’s visits, insurance verification, treatment plans, claim submission, etc. Each step of medical billing  has a lot of documentation with crucial information, each of which plays a crucial role in claim  reimbursement. Various surveys have stated that a considerable amount of claim  denials happens because of insufficient or inaccurate information, which is majorly caused by  unorganized documentation. In the medical billing process, it is very vital to gather and update patients’  information, along with required clinical data. Efficient compilation of information not only eradicates the  scope of errors & duplicate claims but also reduces the turnaround time of insurance claim  reimbursements.
   Solution: Medical billing companies emerge as saviors in such situations. Medical billing companies not only  manage the documentation of the complete billing cycle but also use advanced software and tools for data  management. Advanced tools used by these medical billing companies enable automated information  updating such as social security numbers, demographic codes, etc., eradicating any scope of errors in  documentation. 
2. Errors in Medical Coding and Data: It is vital to ensure that each step of the revenue cycle is accurate and  streamlined in order to avoid any claim denials. Multiple studies have proved that errors in medical coding  and claim submissions are one of the major reasons for claim denials. For instance, filling incorrect medical  codes, not attaching a few of the required documents, missing or incorrect patient information, filing  duplicate insurance claims can lead to claim denial.
   Solution: To avoid such scenarios, healthcare professionals should ensure that the medical biller is an expert  in the healthcare and insurance domain. Furthermore, healthcare professionals should also ensure that the  medical biller gets periodic training to stay up-to-date with changes being done in medical codes, healthcare  & insurance programs’ rules, regulations, and protocols in order to avoid any errors that can adversely  affect revenue flow within the system.
   
3. Lack in Denial Management: Claim denials can drastically be reduced if RCM is streamlined. However, this  is an inevitable step that every medical professional has to handle. Nevertheless, claim denial does not posit  revenue loss.  
   Solution: Effective denial management can convert claim denials into a clean claim. The first step to attain this is understanding the difference between a denied vs rejected claim. Rejected claims possess certain  errors like incorrect medical codes, lack of documents, etc., while denied claims are termed unpayable by  the insurance companies. To comprehend these issues within the submitted claim it is important to decode  each point mentioned in the Explanation of Benefits (EOB). EOB clearly states the reasons for  underpayment, rejection, and denials. Contemplating each cause and taking a necessary step can fasten the reimbursement process. Furthermore, rectifying the problems mentioned in the EOB and taking timely  follow-ups can make a great deal of difference in the reimbursement turnaround time of the resubmitted  claims.
   
4. Stacking-up Clearing House Reports: Most medical professionals are burdened not only with providing  medical service to a lot of patients, but also with other clinical and management tasks. Because of handling  multiple tasks, medical professionals do not get enough time for clearing house reports, leading  them to stack up over time. However, when these reports are piled up, it can become an arduous task to identify the problems and bottlenecks within each of them. This results in delayed reimbursements, and in  some cases revenue loss if not corrected and submitted on time.
   Solution: Stacked up clearing house reports can be one of the major reasons that hinders cash flow within  the system. Therefore, it is very necessary to monitor reports in a timely manner, identify the root causes  of the underpayment, rejected and denied claims, and resubmit the claim within given deadlines to ensure  timely reimbursements.  
5. Not Outsourcing Medical Billing Service: Medical billing is an intricate part of the healthcare system with  multiple steps to be managed and monitored to attain error-free systems and timely reimbursements.  Management of medical billing requires a profound knowledge of healthcare systems, programs, insurance  policies, medical coding, and whatnot. Additionally, it requires undivided focus and time to attain the  required accuracy level to avoid any claim denials and throttled cash flow. However, it can be a strenuous  job for medical professionals to handle as they are already burdened with various other tasks within the  healthcare system.  
   Solution: Medical billing companies, like Capline services, have a team of experts who are periodically trained to stay up to date with the changes in the protocols of healthcare as well as insurance programs to  handle each step of RCM along with advanced tools to streamline the complete process. Various researches  have proved that outsourcing medical billing has drastically improved the revenue cycle within the clinics. These companies not only reduce the burden from medical professionals but also make the system error free and effective.