You spend your time providing the best medical care possible for your patients. But when was the last time you thought about checking up on your practice’s financial health? Here are five tips to encourage timely payments, streamline processes, and speed up reimbursements to help make your practice more efficient.
Tip #1: Communicate Patient Financial Responsibility Clearly
You can make it easier for patients to understand the cost of their medical services by providing a clear financial policy as part of your check-in process. Most patients will probably appreciate knowing your co-payment collections process, cancellation and no-show policies, and how your office handles insurance claims upfront to avoid any surprises or confusion later.
Additionally, the implementation of price transparency at hospitals is moving the needle towards greater price transparency throughout the entire healthcare industry. Many practices are adopting this trend and providing cost estimates to patients upfront. This can help underinsured patients budget and plan ahead for medical bills since they have a better idea of what to expect. Timely insurance verification is key to determining a more accurate cost estimate.
Tip #2: Avoid Common Coding Errors
Sometimes providers overlook adding codes for problems that present and are addressed during a visit that could be billed for separately at the time of service, if allowed by the payer. For example, a patient comes in for a routine prenatal visit. They complain of pain during urination, and following an exam, you diagnose a case of bacterial vaginosis. Beyond prenatal codes, you may be eligible to code for ICD-10: N76.0 (Acute vaginitis), as well as CPT: 99213 (office or other outpatient visit for the evaluation and management of an established patient), which requires a medically appropriate history and/or examination and low level of medical decision making or 20 minutes of total time met on the date of the encounter.1
Another common area where coding issues can arise is when a new physician is hired and starts seeing patients before any credentialing has been completed with applicable payers. This can lead to denied claims as well as out-of-network claims. As a result, the patient might have to pay more out of pocket, or the practice may need to hold claims for that physician until credentialing is complete. In the meantime, the practice might limit the physician’s appointments to patients with certain insurance plans during the credentialing process.
Mistakes like these can lead to lower reimbursement rates, so it’s important to keep current on best coding practices. The American Medical Association establishes and publishes the national coding guidelines. Many national specialty associations also have coding resources available such as the American Academy of Ophthalmology and the American Academy of Dermatology. The Medicare Learning Network also offers booklets, online courses, webinars, and other resources. If you are interested in obtaining a coding certification for yourself or your staff, the two most common certifications are offered by the American Academy of Professional Coders and the American Health Information Management Association.
Tip #3: Improve Claims Scrubbing Before Submission
Clean claims are essential for timely reimbursements from insurance payers. When a claim is denied, the coding is often the first area that’s scrutinized when it comes back to the office. But there are many other reasons a claim could be denied that can be much harder to spot.
For example, incorrect patient demographic information can cause a denial. Because there’s a high level of focus on the patient’s information, it’s possible that the provider’s information is inaccurate and could be overlooked. In addition, submitting a claim outside of the claims submission period for a payer can also lead to problems2. Billers need to pay close attention to the details on a claim to ensure it’s clean.
Claim scrubbing tools can create efficiency for your practice by automating certain accuracy checks prior to submitting to clearinghouses or payers. If there are errors, some systems return claims to you with notifications to guide you through corrections.
Tip #4: Generate Clear Statements and Bills
For many medical specialties, diagnostic testing and screening are considered a routine part of many types of visits. But that doesn’t mean the patient understands that they will be charged separately for these services and potentially billed by a different company. In some cases, patient bills go unpaid because there’s confusion about what insurance will cover. Patients may even assume a bill is a mistake.
Communicating a patient’s financial responsibility at the start of their visit helps set clear expectations. Providing a final bill that includes details such as insurance coverage, deductibles, and any third-party charges (e.g., pathology or imaging) allows patients to fully understand what they are paying for and why.
Posting this bill to an online patient portal reassures patients that they can securely reach out with any questions and conveniently pay their balance when it’s due.
Tip #5: Provide Options for Patient Payments
It’s simple — the more options patients have to pay their bills, the more likely your practice is to collect what you’re owed. Patients are used to paying for goods and services on their phones, computers and tablets. Your practice can take advantage of how patients already prefer to pay by offering Text-to-Pay, portal payments and more.
Follow these tips to refine your billing and coding practices, and take steps toward increasing your practice’s efficiency.
