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Medical billing claims are very extensive and complex processes. Making improvements and tracking the effectiveness of these steps helps in a smooth billing process. 

As it is a very long process the probability of errors is much higher. The medical claim billing process involves preparing the data of the patient, processing it, coding, submitting a claim, tracking denials, and submitting a claim.

There are some of the steps involved in the process.  Let’s read them below!

Medical Claims Billing Process Steps 

1. Maintain Patients Records: 

For a successful medical claim, the first step is to maintain patient records effectively. The records must be updated and managed well, any kind of error or mismanagement may create a negative impact on claiming. 

A patient record may consist of his name, address. Age, demographic, and his insurance-providing company. Make sure you communicate well with patients as better communication helps to collect accurate information.

2. Negotiate About Financial Responsibility: 

The second step is to ask the patient about the details of his/her insurance provider. See all the details of the insurance contract and figure out which services are included and which treatment and services are excluded. 

Tell the patient about the insurance agreement earlier, guide him about which treatment will be paid by the insurance company and which services are excluded from the insurance agreement and the patient has to pay for it. 

3. Keep Away From Duplicate Billing: 

During the billing process, it has been seen that duplicate billing arises more often, which makes this process more complicated. With the extensive amount of data, it might be possible that a double-entry might be generated. So it’s good to have a close look at patients’ records to avoid these kinds of errors.

4. Automate Your Billing Services: 

An automated billing process can help in reducing time and enhance the chances of positive returns. 

Automation assists the workers to maintain and enter the records more accurately and allow them to focus on other important things.

5. Improve Coding: 

Proper coding is an essential element for a successful claim. It helps the insurance provider to find out what kind of treatment is acquired by the patient. 

Make sure the use of correct CPT & HCPCS provides additional information about the services the patient received during his/her stay in the hospital. 

It is very essential to set up proper coding which enhances the chances of getting paid by the insurance company abruptly. 

6. Monitor Denial Management:

Tracking denials are a very common and tedious process, it is the part that can impede the whole billing process. Commonly there are some reasons behind it, like improper coding, lack of experience by the workers, and insufficient documentation. 

Denials may also occur when the claim is not submitted at the due time, it may make the process of billing even longer, as some insurance companies only approve the claim when they are submitted on time. 

Another reason for denials is the wrong documentation. In this scenario, there are possibilities that both the sites filled their documents wrong. It might be the fault of the insurance company as they missed something in the document or maybe the fault of the claimer who somehow didn’t make the documents properly. 

It’s good to have checks and balances when you are constantly receiving denial rates, by monitoring the denial rates you can easily figure out the things to make your billing process smooth. There are few steps that could low the denial rates. As most of the denial rates occur due to faulty documentation, the proper training of the workers helps in some ways.

Sending daily charts by the health worker to the billing department is the one process that makes things even clearer and easy. Coding could be made better by adopting that practice.

If still, the denials rates are not decreasing then a short review of your daily billing process activities can help to deal with it. 

7. Hire An Outside Billing Management Firm: 

Outsourcing the team of experts who manage your billing process is a great way to get rid of many of the problems. Working with a team of experts will free health workers from doing the complex process of billing so they may be more focused on managing patient treatment. 

Outsourcing can help to maximize your cash flow better because they have a team that assists you to make proper management of your revenues with fewer denials. 

With extensive support and excellent relationships, The Mediators have a track record of 100% customer satisfaction. From daily quality assured claim submission to daily denial management monitoring to immediate payment posting with no sign-up cost. 

8. Assure The Quality: 

For an effective billing process, one must assure good quality, as revenue is at stake so ensuring good quality is a must-do thing. You can simply assure the quality by maintaining a patient log in which all the essential details related to the patients must be added, like his/her name, address, treatment, account number, pending dues, etc. 

Taking a close look at the pending amount and comparing the data with prior records and making a quality estimation for its proper management. 

The healthcare industry is drastically changing and it is estimated that new trends could replace the traditional setup. To cope up with the changing technologies one must be able to forecast and make constant changes in his strategy.

Quality assurance is a need to get effective results, nowadays the billing process is assisted by EHR & EMR, Termed as the Electronically generated health records of the patient. It makes the claim more effective and easy. The good working quality of these frameworks assured better claim management. 

Want To Improve Your Billing Process Today? 

If you are tired of managing your billing process and still not able to get desired outcomes. Don’t worry. Med-Miles LLC is here for you. Our vision is to provide a smooth billing process with maximum profitability. Feel free to call us at (888) 598-9181 for further information.