Physician billing is arguably the most crucial non-patient-related operation in your practice. Revenues suffer when it’s not done well. Most physicians have a general understanding of how the medical billing process works:
- Patient information is entered into the EHR.
- CPT and ICD-10 codes from the bill are entered into the patient’s record.
- Claims are transmitted to Medicare and insurance providers.
- Audit reports are received and reviewed, errors are corrected, and rejected claims are resubmitted.
- Payments are posted to patient accounts.
- Patients’ accounts are reviewed to see when bills aren’t paid on time.
But it’s important to fully understand all the steps in the process and employ best practices to help maximize timely, accurate payments. Periodic reports ensure that the billing group is functioning properly. Your billers should report the following information:
Rolling accounts receivable: By looking at accounts receivable (AR) information across increments of one to 30 days, 30 to 60 days, 60 to 90 days, 90 to 120 days, and 120-plus days, your billing department will be able to see when it is or isn’t posting older AR, and whether or not billers are following up on denials. Keep an eye on AR in every office and per each physician.
Medicare payments: An effective billing department scrutinizes Medicare payments as closely as CMS does. If Medicare stops paying on services by a specific provider, your biller must be able to quickly see the stoppage, figure out why Medicare payments have stopped, and correct the situation if Medicare has wrongly stopped payments. Knowing the period of stopped payments ensures your practice gets paid for any back amounts. If Medicare caps or specific allowed amounts apply to your practice and procedures, you must be aware of these restrictions so you don’t miss out on being paid.
Payment summary and billed claims: Payment summaries track collection of patient copays and coinsurance, as well as whether insurance payments have been posted. Your office should keep an eye on when claims are billed. If no one is responsible for checking to see if claims are billed out, they may never be sent.
Many insurer payments are delayed because practices submit claims with vital information missing. Your EHR should enable reports that alert billers to missing information, such as medical notes and charges, before they are allowed to send the claim through the reimbursement process.
Adjustments reports: Monthly adjustments reports identify clinical errors, the types of payment adjustments made, and whether your practice agrees to these adjustments.
DSO (days sales outstanding) reports: These reports show the amount of time that elapses from the date a patient is seen to the date your payment is received and posted. Quarterly reviews of AR gauge whether billing staff are following up on unpaid claims and what adjustments might need to be made.
Yearly reviews of all reports will show your office’s performance vs. your goals for the year. These reports should be kept for longer-term trend spotting and evaluating whether your goals are accurate or need revision.
Not a one-person job
By now it should be clear that the medical billing process shouldn’t belong to a single individual. The medical coding part of the process involves front office administrators, such as receptionists, as well as the medical biller and coder.
Some offices outsource coding or billing to specialist companies, whose sole purpose is to keep billing on track and running as smoothly as possible. The drawbacks of outsourced billing are similar to those encountered by other businesses, namely, the possibility of security breaches, loss of autonomy over day-to-day activities, and potential loss of collected revenue.
For offices that keep billing in-house, staff must understand each patient’s responsibility for payment, as co-pays and deductibles differ by health plan. Staff must also generate accurate billing that takes disparate insurance coverage and medical charges into account. These tasks require many specific responsibilities within the medical billing process.
No matter who does it, tracking financial performance data is key to your overall success. Although the tasks associated with billing can seem overwhelming to small offices with minimal staff, monitoring your fiscal fitness consistently can make a difference in your practice’s bottom line.