Introduction
Revenue leakage means that a healthcare provider does not get paid by insurance for their services. This happens when they do not get the payment they are owed for a long time, and sometimes they do not get any money at all. It is a big problem for healthcare practices because it makes it hard for them to do their everyday work smoothly.
But here is the good news: doctors can do things to fix this problem. They can find out what is causing the revenue leakage, improve their processes, and try to improve. In this article, we will discuss seven ways to ensure healthcare providers get paid for their services.
7 Tips To Minimize The Revenue Leakage In Medical Billing
Submit Claims Promptly
Your billing team’s main job is to quickly send insurance claims, ideally within 24 hours of the patient’s visit. Before the patient comes in, your billing team should have all the necessary information, like the patient’s details, insurance info, coverage, patient responsibilities, referral number, and any needed prior authorization.
Once your coding team gives you the procedure codes and modifiers, you can send the claims fast. Sending insurance claims quickly has many benefits, such as getting a swift response from the insurance company, fixing rejected claims, and reducing accounts receivable days.
Different insurance companies have various time limits for filing claims, ranging from 3 to 12 months. It’s best not to wait for these limits because a claim can be rejected at any point. If it comes back to your desk, you’ve already wasted a lot of time.
To make sure you file claims on time, follow these best practices:
- Use billing software.
- Submit new claims every day.
- Check benefits verification daily (including prior authorization).
- Work on rejected and denied claims.
Step 2: Enter the Right Claim Info
Mistakes in patient and insurance details cause most claim rejections. Common reasons for rejections are wrong birth dates, names, subscriber numbers, zip codes, and subscriber info. When a claim gets rejected, it stays in the billing software until it is fixed and can not go to the payer. To reduce these rejections, make patient registration better. Double-check that every patient’s info needs to be correct. You have a few ways to do this. You can use the provider portal or clearinghouse services. Some billing software can give you reports with one click, or you can call the insurance rep. Doing these things can cut claim rejections to just 5%, and you will spot prior authorization needs too.
Step 3: Checking Your Insurance Coverage
You can check if your insurance covers your medical expenses to prevent revenue leakage. During this process, the billing team will look at whether you’re allowed to have certain procedures and what benefits you can get. If you don’t have insurance, we can discuss getting different coverage. This process also helps us figure out if we need permission before doing certain treatments. Checking eligibility and benefits makes sure you’ll get paid for the services you receive because you have insurance.
Step 4: Conduct regular Audits
Healthcare audits can help you recognize the anomalies and errors in the system and help you adopt healthy measures to find an approach toward medical billing. Medical billing audit services ensure doctors and hospitals are paid the right amount. They look at the bills and codes to find mistakes. Mistakes can make them get less revenue or even none. These checks verify that everything is correct and gets paid for properly. They also help follow the rules so no fines happen. This way, they help get the most money and avoid losing it. They ensure that healthcare places get all the money they should
Reducing Coding Errors is Important
Medical coding is a big deal for managing money in healthcare. It can be tricky because the rules change a lot, and different insurance companies and states have their own rules too.
- Common Mistakes: People often make mistakes like using the wrong codes, missing important details, or not coding correctly for a specific medical area. This can cause problems for your practice.
- Don’t Do It All Alone: Many practice owners try to do the coding themselves, but that’s not a good idea. They might use the same codes for all patients, which is not right. It can lead to problems with the law and less money for your practice.
- Get a Qualified Coder: You really need a coder who knows what they’re doing. They should have experience in your specific medical field and be certified. They’ll ensure the coding is correct and use the right codes.
- Keep Them Updated: your coder is up-to-date with the latest coding rules. This helps avoid mistakes and keeps your practice running smoothly.
Dealing with Denials in Healthcare
Denial management is like solving problems when medical claims get rejected. It also helps stop future rejections. Not fixing claim rejections can make a healthcare business revenue leakage. A recent survey says claim rejections have gone up 23% in four years, costing loss of thousands of dollars to immediate care clinics in Algonquin. However, timely resubmission or follow-up can help to overcome the denial rate.
Here’s what a complete denial management process looks like:
- Find out why claims are getting rejected.
- Fix the rejections.
- Keep an eye on things.
- Stop the same rejections from happening again.
Conclusion
To stop losing money in healthcare, follow these steps.
First, your coding and billing are correct to avoid claim rejections. Teach your staff about changes in coding and billing regularly.
Next, improve your money process by making admin work smoother and improving patient sign-up. Use tech to find and fix money problems.
Then, make strict rules for dealing with rejected claims to fix them quickly. Check your payment owed and ask for payment if you need more.
Last, help patients pay by offering different pay methods and telling them about their money duties.
These steps will stop you from revenue leakage and make your healthcare place financially better.
