So many hospitals and practices miss out on revenues by having a less than effective billing process. Practice and Hospital Medical Coding, claims follow ups and accounts receivable issues all work against you when it comes to reaching optimum revenues. Here are a few ideas to help you improve your billing process and in turn increase your revenues.
Local Coverage Determinants
Make sure whoever does your billing knows their local coverage determinants. LCD’s explain everything a biller needs to know from what procedures are covered to procedures that are considered medically necessary as well as special and regular billing guidelines. This will help ensure you are paid the first time around.
It is important that submission reports are being tracked and reviewed on a regular basis in order to determine what claims have been denied. Understanding rejections will allow you to act on further claims that may have been done incorrectly so that you can avoid further rejections. These claims can be updated and resubmitted in a timelier manner. You will also be able to track claims that were never received.
Act on Denials and Appeals
Hospital medical coding and practice coding used and submitted incorrectly can lead to denials. In fact, sometimes the payers misinterpret the rules and may incorrectly deny the use of codes even though they were used correctly. You want to act on appeals when you know you are in the right. Many billers list appeals and denials low on their priority list when in fact much of your revenue is dependant on disputing denied claims. Having a professional billing service can help avoid denials to begin with as well as help denials be reclaimed in a timely manner.
Keep up on Fee Schedules
Most hospital departments and practices have a set of codes they use regularly. Having up to date fee schedules for the main insurance companies will allow you to quickly identify when a claim has been denied or underpaid in error which means you can reclaim. Many revenues are lost due to insurance claim payment errors.
Check Online Eligibility
Insurance companies have real time online eligibility services that allow you to not only check a patient’s benefits and eligibility but to claim payment on the spot. Most practices and hospitals do not have the resources to do so but if you do, use it.
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