If your clinic doesn’t want to waste time and money on health insurance deductions and other problems, it is essential to implement an effective medical billing billing process.
Below, you will better understand the main mistakes to avoid, the necessary care when carrying out this process and the step-by-step process for invoicing.
Let’s go!
Medical Billing Process
Medical billing can be compared to the finance department of a company.
After all, your role is to record, process and collect the amounts owed for the services provided by the clinic to patients.
After a medical consultation, this sector must record all details of the service, such as date, professional responsibility, diagnosis and procedure performed, among other information required by the health insurance plan.
Based on this data, an invoice is generated and sent to the patient’s health plan.
And if there is any gloss, that is, an amount not paid or questioned by the health plan, the billing department will be responsible for analyzing and resolving the situation, ensuring that the clinic receives payment correctly.
The 6 common medical billing errors that “steal” money from clinics
Any error in the medical billing process can be fatal and result in a refusal of payment by the patient’s health insurance plan.
Furthermore, inconsistent information can lead to poor decision-making, creating greater challenges in the future.
Therefore, medical billing process is essential to pay attention to these, which are the main mistakes made in this area:
1) Errors in coding procedures
It is essential that the procedures performed are properly coded in accordance with the health information and standard.
Let’s say a doctor performs surgery and, when registering the procedure, uses an incorrect code that does not correspond to the procedure performed.
This will inevitably result in a disallowance by the health plan, as the code does not match the procedure actually performed.
2) Lack of adequate documentation
This is another common problem that leads to medical glosses or delays in receipt by the health plan.
Imagine that, during the consultation, the doctor performs a complete assessment of the patient’s history, performs physical examinations, requests additional tests and provides a diagnosis and treatment plan.
However, when recording all of this in the electronic medical record, he forgets to include some essential elements, such as cardiology medical billing, detailed notes on the clinical history, clinical findings and instructions given to the patient.
This medical billing process is enough for the health plan to contest the need and scope of the services provided.
3) Lack of knowledge of health plan rules
Each health plan has its own rules and billing policies. Therefore, it is important to know and follow these guidelines to avoid problems in the billing process.
It is very common, for example, for a doctor to perform a surgical procedure and use a specific material that is not covered by the health plan.
As a result, the plan rejects the charge for that specific item and the doctor does not receive reimbursement for the material used, causing financial loss to the clinic.
4) Lack of checking and reviewing accounts
It is essential to carefully check the information contained in medical bills, such as amounts, dates and other data, to avoid errors that could lead to delays or disallowances.
This is a recurring problem, especially in clinics with several appointments per day, involving different health professionals and procedures performed.
Due to the high demand and complexity of information, it is common for errors to arise when providing information in electronic systems, such as incorrect values, duplication of procedures and the omission of important data.
If there is no daily review and conference routine, the clinic will struggle to receive these amounts from the health plan.
5) Errors in negotiating contracts and values
Imagine that a medical clinic has contracts signed with different health plans to provide services to patients.
Each of these plans, as we know, has its own price tables and specific rules for payment of the procedures performed.
However, due to failures in contract negotiation or the lack of updating of value tables, errors may occur that directly impact the billing of medical bills.
For example, the clinic may be charging lower amounts than those established in the contracts, which results in financial losses.
Likewise, it is also possible to charge amounts higher than those agreed upon, which can lead to disallowances or dissatisfaction on the part of health plans.
A practical example of this type of error is when the clinic performs a procedure and uses an inappropriate code for the medical billing process, which results in a lower than expected value.
In other words, This difference will not be paid correctly by the health insurance company, generating losses for the clinic.
Another example is when the clinic does not adequately update the price tables negotiated with health plans.
Suppose there is an annual adjustment in the costs of procedures, but the clinic does not carry out this update and continues to charge the old amounts. This may result in deductions or even termination of the contract by the health plan.
6) Lack of monitoring and analysis of glosses
It is essential to regularly monitor and analyze the glosses received to identify patterns, recurring errors and opportunities for improvement.
If a medical clinic does not perform a regular analysis of the disallowances received and does not take corrective actions, it may continue to make the same billing errors and face recurring financial problems.
Be smart and get ready for the medical billing agencies offered by the WMB Newark, USA.
