When a Florida hospital saw no insurance collections for months, it faced potential closure. No claims had been submitted, and the in-house billing department claimed ignorance. With the billing system unable to generate reliable reports, and no electronic health records system to provide guidance, administrators were at a loss to explain the drought.

The team from Medical Claims Consultants (MCC) was hired to conduct a revenue cycle audit. They found dozens of file boxes strewn about the billing department. Medical records, face sheets, and encounter reports had been neither prepared nor submitted.

After 30 days, a complete audit organized the paperwork, including all supporting documentation. MCC prepared for submission $800,000 in still-current claims. Lost, however, were untold thousands of dollars in delinquent claims that had aged out.

But the hospital returned to positive cash flow.

Medical Billing’s #1 Enemy

Poorly handled claims are sapping healthcare provider profitability. Downcoding, billing and coding errors, delinquent insurance claims submissions, and poor revenue cycle management by medical practices has U.S. doctors losing out on an estimated $125 billion a year in receipts. That doesn’t include revenue lost by hospitals and health care facilities.

Add to that back-office staff confused by electronic health records software and new ICD-10 codes required as part of healthcare reform, and there’s arguably no remedy insight.

Submitting accurate, complete, and timely insurance claims for services rendered is an increasingly complex process faced by doctors, medical practices, and hospitals and healthcare facilities. As the example above revealed, in-house billing departments, especially with little administrative oversight and no software to provide assistance, are not always the best solution. An outside medical billing and collections provider can help improve performance and heighten returns.

How can a medical practice or healthcare provider improve performance? We sat down with our CEO and co-founder, Mayra Perera to bring you ideas on how to help your organization.

5 Steps to Boost Medical Billing & Doctor, Hospital Profits

• Create a holistic process. From incorrect or incomplete documentation by the physician, to incorrect claim submission, to untimely follow up, claims have a higher likelihood of being delayed or denied. An internal department, in tandem with a medical collections partner, can improve and stay atop coding, billing, payment posting, follow-up, and collections, if necessary.
• Compare services rendered to services billed and retain all eligibility and supporting documentation. If a doctor saw 250 patients and rendered 400 billable services last month, does that figure match what was submitted? Additionally, the scrubbing system may filter some diagnoses. However, insurance companies may not pay for certain diagnoses because of a non-specific diagnosis. It’s up to practitioners to note the specific payable diagnosis to support the medical necessity for services rendered. Additionally, front office staff must verify and update patient insurance eligibility with every encounter, and secure correct authorization codes for services to be rendered.
• Track aging claims. The clearest way to determine if a medical practice or facility is suffering from insurance collections is by tracking aging claims. Submissions approaching or exceeding 90 days not only may be permanently denied for payment. They may reflect habitual late filing.
• Collect patient responsibility at the time of the visit. This will eliminate collections later. If payments are not made or collections are delayed, the Payment Posting department should track delinquencies and refer for collections.
• Stay atop the process. Health care billing and collections are complicated, even for highly skilled back offices. A medical billing partner can accelerate submissions, improve tracking, post payments, and pursue collections to keep receipts current or accounted for. Skilled medical billing providers also can deliver results exceeding industry benchmarks for maximized reimbursement. For example, MCC ensures 48-hour claim filing and averages 98% first-pass resolution rate, 98% coding accuracy, 97% net collection rate, 12% or less of accounts receivable exceeding 120 days and 30 days or less in A/R.

The Solution

A medical collections partner can help structure workflow to improve the claims process and reduce the need for follow up. When time required to chase errant claims averages 10 minutes, any process improvement can elevate staff productivity and reduce remittance times.

Medical billing and collections is a team effort. With better training of back-office staff, and the engagement of a medical billing partner with teams trained on the latest software applications integrated into the practice’s EHR, medical practices and healthcare facilities can improve billing practices and enhance practice revenue.

About our CEO

Mayra Perera is CEO and co-founder of Medical Claims Consultants (MCC). Founded in 1993, the Miami-based firm’s AHIMA-certified billing and coding experts provide medical billing and coding services and comprehensive collections and revenue cycle management service to 14 hospitals and more than 40 private physician practices in 50 clinical specialties. MCC also provides client CMS, Medicare, and Medicaid recertification.