04 Key Steps in Medical Billing Services for Increased Profits

04 Key Steps in Medical Billing Services for Increased Profits

Medical Billing may seem complex and a complicated task to execute if you do not have the necessary expertise in claims handling. It requires a good knowledge of the medical specialties with a great understanding of ever-changing payer guidelines.

You may think of doing medical billing on your own or might just end up outsourcing the same to a medical billing services provider. Either way, you need to be sure that each step in this process is executed with accuracy so you only witness business growth.

medical billing steps

Patient Demographics

This step involves collecting information about the patient. His personal health insurance details like name, DOB, Address, Insurance Member ID, C.O.B. (Coordination of Benefits) details etc. An A.O.B. (Assignment of Benefits) is made to be filled up at the time of appointment. These details are necessary for eligibility verification purposes and ascertaining the fact that the services which are about to be rendered are actually covered by the insurance company. Failure to successfully verify these details may give rise to unwanted rejections from the clearinghouse or denials from the insurance company at the time of claim processing.

Insurance Eligibility Verification

Insurance eligibility verification can be done in two ways – Electronically and Manually. There are software in the market which allows you to verify eligibility via their own secure channels. You just have to click over Insurance Eligibility and it gives you the entire status of insurance coverage including the Start and Term Date. The second method to do this is calling the insurance eligibility lines and verifying it with the insurance representative only. This is an important step as verifying all the information may help in preventing “Out of Network Services and Provider – Out of Network” denials or “Incorrect Patient Information” rejections from the clearing houses in the first place itself.

Preparing Sales Orders

A sales order is normally an invoice containing all the treatment information and the charges associated with each treatment procedure or services provided. This is yet another important step which needs to be executed carefully. Any failure in recording correct modifiers with the procedure codes or assigning correct CPT codes for the services may end up generating those unwanted denials which will do nothing except raise your AR percentage and denial rate. The charges for the services also need to be recorded as per the pre-decided fee schedule of the insurance company you are billing for.

Claim Submission

This step involves the final submission of prepared claims to the insurance through secure electronic means via web portals or billing software, fax or via paper means on the correct postal mailing address. Of course, that would seem simple. But there’s a catch. The claims need to be submitted well before a deadline normally called as the TFL or Timely Filing Limit. A timely filing limit is the time period pre-decided by the insurance company before which the claims need to be submitted. Failure to do so would invite denials related to “Submission beyond TFL”. And I am sure you would certainly won’t like spending hours to advocate on them and sending appeals or reconsideration requests. If you’re looking to reduce your claims AR percentage and denial rate, Bikham Healthcare is the perfect choice for you. With our efficient outsourced medical billing services, we help our clients witness increased revenue and improved business performance. Visit www.bikham.com to know more about our profitable medical billing services.

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