8 Ways to Improve Your Medical Claims Billing Process
Aug 28, 2021­­8 Ways to Improve Your Medical Claims Billing Process

Your practice’s medical claims billing process can make or break your revenue cycle which will have a significantly detrimental effect on your bottom line. High claims denial rates, slow reimbursement, and delinquent accounts can all point to problems with your billing processes. Here are eight ways to improve your medical claims billing process. 

1. Improve Your Medical Claims Billing Process by Keeping Patient Records Up to Date

Between appointments, patients may have changes in insurance coverage, addresses, or other information that can affect claims and billing. Out-of-date information could slow down claims or even result in denials. You can prevent these errors by building patient information updates into your office visit workflows. With tools like NextGen Patient Portal, patients can update their information online. Implementing kiosks such as OTech or Phreesia can enable patients to update their demographics and insurance right in the waiting room.

2. Improve Your Medical Claims Billing Process by Building Coding and Documentation Into Your workflows

A strong medical claims billing process starts with accurate coding and documentation. Your EHR system can prompt providers to enter coding and documentation during office visits. But excessive documentation requirements can lead to provider burnout. By building coding and documentation into your office visit workflows, you can help providers accurately code patient visits in their normal workflow which reduces or eliminates post-visit work.

When developing your coding and documentation workflows, include both providers and medical billing specialists. Providers can help you develop a process that minimizes burden, while medical billing staff can identify key areas for strengthening documentation and coding accuracy.

Third-party EHR consultants like TempDev can help you identify workflow problems that are causing denials, develop new workflows, and train your staff to follow them confidently. They can also help you modify your templates to ensure coding is not missed due to providers following a different workflow.

3. Improve Your Medical Claims Billing Process by Integrating Practice Management Billing Software With Your EHR

Your EHR is not just a powerful clinical tool. It can also improve your finances. When combined with practice management billing software, your EHR can take you from office visit to reimbursement faster and with fewer errors. An integrated EHR and practice management system reduces data duplication, manual data entry, and associated errors.

For example, NexGen Practice Management draws data about patients and encounters from your NextGen EHR system to help you bill your payers more quickly and accurately. Within one integrated system, your practice can collect and update patient data, schedule appointments, document visits, and bill payers. This eases billing workflows and helps your practice earn more revenue, faster.

4. Improve Your Medical Claims Billing Process by Automating Simple Billing Functions

Medical billing errors happen. From human error when transferring data to outdated insurance information, minor mistakes can cause claims denials. Where possible, automate any data transfers to reduce simple errors like typos and transpositions. If you have integrated your EHR with practice management billing software, you can automatically pull coding and documentation from patient office encounters to claims. You can also link patient insurance information to payer-specific coding requirements, saving your billing staff from repetitive payer compliance tasks. Even patient insurance eligibility can be automated so you'll never have an insurance coverage denial again.

5. Improve Your Medical Claims Billing Process With Targeted Training

Practice management and EHR training reduces burnout and improves satisfaction with your system. Targeted provider training on coding and documentation can improve the quality of data your billing department receives.

Training should not be limited to providers. Your practice should also budget for training your medical billing specialists. By keeping your billing department’s technical skills up-to-date, you can reduce charge lag time improve your accounts receivable, and lower your claims denials. To get more out of your training plan, consider targeting training sessions by both job role and comfort level with your EHR and EPM system.

6. Improve Your Medical Claims Billing Process with Quality Control Processes

Up to 80 percent of medical bills may contain errors. These errors can delay your reimbursement or result in denied claims. Quality control processes can help your practice reduce your error rate, saving you time. A strong quality control workflow should build on your automated billing processes to ensure submitted claims are accurate and complete. Many practice management systems and clearinghouses include ways to automatically stop or fix claims prior to their submission to reduce denials, however, these need to be configured and consistently updated before they can have a true impact on your revenue cycle.

7. Improve Your Medical Claims Billing Process by Tracking Your Denials

Major insurers deny up to 5 percent of claims. Common reasons for claims denials include late filing, inaccurate insurance coverage information, and data inconsistencies. Your medical billing specialists should promptly refile denied claims to correct problems. By keeping track of claim denials, your billing team can correct errors more quickly, avoiding possible late filing. Practice management systems often have great ways of tracking denials, however, revenue cycle business intelligence solutions can take this process to the next level.

Tracking denials can also help you prevent future claims denials. By studying your denied claims, you can find the common sources of denials for your practice and work to correct them. Tools like TempDev’s Revenue Cycle Dashboard NextGen EPM Report can help you see patterns in your claims denials. The Revenue Cycle Dashboard lets you track denials by payer and reason, helping you find problems and fix them, permanently.

8. Improve Your Medical Claims Billing Process by Managing Your Delinquent Claims

Your practice should aim to receive payment in 50 days or fewer from payers and patients. If you have days in accounts receivable (A/R) over 60, 90, or 120, your medical billing specialists should be consistently following up. These follow-ups are time-consuming, but they can help generate payments or identify the reasons for the delay.

If a few payers, patients, or claim types consistently have delayed payments, it may be time to examine your internal processes. For example, if your practice has significant numbers of patients with delinquent copayments, you could consider collect payment upfront rather than billing after the appointment. If your practice struggles with timely payments from a payer, your billing staff could reach out to see if they need to adjust their billing process to better meet the payer's requirements.

How TempDev Can Help You Improve Your Medical Claims Billing Process

TempDev’s expert NextGen revenue cycle consultants, developers, and trainers can help you optimize your medical claims billing process. From reports, SQL jobs to automate frequent billing routines, CreditFlow, and dashboards to targeted training and workflow redesign, TempDev has the solution you need to improve your revenue cycle.

Call us at 888.TEMP.DEV or contact us here for help with optimizing your medical claims billing process.