Let’s get started with Medical coding errors and how to prevent them in accounts, clinic management must implement a series of measures, such as:
- Team Training:
- Regular training and education for the team responsible for billing, with knowledge of the rules and regulations of health plans, proper use of codes and procedures, updates to value tables, among other aspects.
- Use of specialized management systems :
- Use tools that help control and organize information, with process automation and data validation. These systems also help maintain detailed records of transactions, facilitating later analysis and the identification of possible errors.
- Internal review and audit:
- Perform a periodic internal review of medical bills before sending them to health plans. Thoroughly check the procedures performed, codes used, amounts charged and attached documentation, among other aspects. This will allow you to identify errors before they are sent, avoiding disallowances and rework.
- Monitoring of rejections:
- As we said before, it is essential to monitor and analyze the rejections received from health plans to identify patterns and trends, understand the main reasons for rejections and take corrective measures.
- Monitoring payment deadlines :
- Establish an efficient process to monitor payment deadlines established by health insurance providers. For example, if a wage earner organizes a 30-era limit for fee of invoices, it is mainly to monitor this continually and take the next operation if any delay happens.
- Identify Areas that Needs Improvement
- Define signs to monitor process effectiveness and label fields that need bettering. Examples of indicators include disallowance rate, average payment term, asc billing error rate, among others. This allows you to implement corrective actions and continuous improvement strategies.
- Contract analysis:
- It is always necessary to carry out a thorough analysis of the contracts signed with health plans to verify whether the procedures are being charged in accordance with the contracted tables and values.
- Communication and alignment with the medical team :
- Although challenging, the clinic should always seek to improve communication with doctors to avoid billing errors. Some of the actions may involve internal guides and manuals, practical training and individual feedback.
How to bill medical bills step by step
The physician credentialing services in the medical billing process often vary depending on the structure and resources available at each healthcare institution.
But it is possible to draw up a basic roadmap with the following steps:
- Data collection and recording: this stage begins before the consultation, with the receptionist collecting the patient’s data. It then continues after the consultation or procedure, with the doctor recording the patient’s history, procedures performed, materials used, tests requested, classification codes and other relevant records.
- Coverage verification: In cases of medical procedures, check whether the patient has health insurance coverage. Otherwise, it is necessary to register the service as private.
- Procedure coding: Use the correct classification codes for each procedure performed. It is important to be up to date on current classification tables and follow the guidelines established by the competent bodies.
- Review of information : Review all the data provided before sending it to the health plan, following the parameters and guidelines of the contract signed between both parties.
- Issuing bills: With the data and procedures correctly recorded, issue the medical bills, including all relevant information and the amounts to be charged.
- Monitoring and resolving pending issues: Monitor the status of submitted accounts and check for pending issues or denials. If problems occur, take the necessary measures to resolve them, such as correcting errors or carrying out administrative appeals.
Additional measures to minimize the costs of your medical clinic
An additional measure to further optimize your clinic’s costs is to hire an accounting firm specialized in the healthcare sector .
This way, your clinic will be able to count on the best tax strategy for your business model, considering resources such as hospital equivalence and even the recovery of amounts related to taxes paid in excess over the last five years.
Do you want to know how Wise Medical Billing can help reduce tax costs and increase your health clinic’s profits?
