Crucial Medical Billing Processes for 2022

“Sometimes a year has been so disastrous and so terrible
that entering a new year will automatically mean entering a wonderful year!”

~ Mehmet Murat ildan

So, what did your independent practice think about 2020 and 2021? Those two years represented quite a struggle for private practices everywhere, as we learned to cope with the COVID-19 pandemic. For a time, we could not see patients in person and had to learn to adapt to the new world of telemedicine. Revenue often took a big hit. Off in the distance, the specters of inflation and supply chain shortages are rearing their ugly heads to threaten even more economic hardship.

That means 2022 just has to be better, right? It can, of course, but that can’t just be some rose-colored view of the world as full of unicorns and rainbows. “Luck” often comes on the heels of good, hard, solid work. For independent practices, that can mean paying a bit more attention to the money side of the equation. Although patient care is, and always will be, the prime directive, focusing on key revenue management practices will give the practice the income it needs to face the challenges ahead.

Although we might not like to talk about it, and some practices can be downright lax in their control measures, medical billing is an integral part of the cash flow process. Poor billing practices mean you don’t get paid for the time you have invested in each patient. Not getting paid fully can eventually mean that you won’t have the cash you need to keep the practice afloat, so you can continue to serve more patients in the coming year (and beyond). This article presents some crucial billing processes and key billing metrics that just might help make 2022 a wonderful year for independent practices.

Top Billing Strategies for Private Practices

“Cheers to a new year and another chance for us to get it right.”

~ Oprah Winfrey

Always the dispenser of great advice, Oprah toasts the beginning of a year as a chance not to focus on what went wrong before, but instead to look at what can be changed to get things right. An inefficient billing system in the past does not doom your independent practice to a lifetime of billing inefficiency. Changes can be made, and processes can be adopted that will set your practice on the path to financial strength.

Before the year, or even the first quarter, begins to get away from you, however, here are some of the top billing strategies your private practice can utilize in 2022 to help it survive and thrive:

Upfront Practices

Used most often in the field of computer science, the adage of “garbage in, garbage out” applies equally as well to the medical billing process. This is the concept that putting in useless data can only result in a useless output. If your office relies on incorrect or outdated patient and insurance information, then your claims process will produce shoddy results. Use a Practice Management System that allows you to know more at check-in by electronically confirming eligibility and claim status. Receive smart alerts that notify you when patient data needs attention, so it can be updated or rectified before you even get to the claim submission process.

Improve Charting

Your medical office cannot receive full compensation if providers do not submit accurate and complete information to coding personnel. Common coding errors include non-specific diagnosis codes and incorrect modifiers. Upcoding or undercoding errors often result from poor communication. Better information can be provided with an EHR that is designed to enable clinicians to chart quickly, but also allows for a more complete picture of the provider-patient interaction.

Reduce Billing Errors

Eliminate common billing mistakes that can lead to a denied claim, or a rejected claim that wastes time in resubmitting. The resubmission process can cost precious weeks before your practice receives payment. Common errors include:

  • Incorrect patient information
  • Incorrect provider information
  • Incorrect insurance information
  • Duplicate billing
  • Incomplete documentation
  •  

Many of these errors are easily rectified with a medical billing service that can result in 95 percent of claims being paid on first submission.

Denial Management

Denied claims must be addressed quickly and decisively. Instead of just getting upset about denied claims and resubmitting them, analyze the reasons for denials and implement needed changes. Perhaps better staff education, improved scrubbing process, or experienced billing service could help to spot and eliminate common denial reasons including:

  • Insufficient physician credentialing
  • Missing or incomplete supporting documentation
  • Utilizing codes that are not recognized or covered by payers
  •  

Improved charting notes and better communication between providers and coders can help to improve claim accuracy. A large percentage of non-covered rejections could indicate that your verification process needs improvement.

Shorten Claim Time

Get the correct claim out the door to the right payer as quickly as possible, and track payments to make sure you are getting paid as quickly as possible. Timely claims submissions lead to more timely payments. Your billing software can assist in this process by allowing payer remittance and patient payment posting, including EOB scanning and payment verification.

Maximize Claims Process

Use technology that helps to speed up and refine your claims process. Denied or rejected claims need to be highlighted quickly and resolved promptly, so they can be resubmitted.

Payment Posting

In October 2021, Medical Economics posted an insightful analysis explaining the importance of the payment posting process as an important step in the medical billing cycle. According to the article, “When optimized for efficiency, payment posting is the lynchpin for simplifying billing, alleviating many administrative burdens and identifying new revenue opportunities to strengthen the bottom line. Because payment posting gives a clear view of the daily revenue stream, it can help practices proactively address errors that otherwise complicate the billing process and impact other aspects of the business.” A strong payment posting process can help to identify payer problems, so they can be rectified before they result in delayed care.

Telehealth Billing

Telehealth services and reimbursement efforts increased dramatically as the COVID-19 pandemic endured. Although many patients are now returning for in-office visits, telehealth has become more recognized as a method to ensure safe, equitable, and patient-centered care. Telemedicine appears to be here to stay, so independent practitioners will need to embrace new collection strategies to ensure they are properly compensated for these services. It is necessary to utilize a HIPAA-compliant and secure telemedicine provider to protect patient privacy, track all virtual encounters, and ensure accurate invoicing for faster reimbursement.

Remote Care

More advances are being made in terms of remote monitoring, but this can add a new level of service to your practice, for which you will need to be fully compensated. Following results, updating charts, changing medications, or talking to patients are all time-consuming efforts that should be tracked as part of your billing process.

Improve Collection Capabilities

Once all payer routes have been exhausted, the final amount due will need to be collected from the patient. Your independent practice must consistently work with patients to collect all outstanding balances. Text and email reminders should be used to remind patients of outstanding balances and keep them on track with any agreed-upon payment plans.

Increase Patient Education Efforts

Patients who do not fully understand the billing process at your private practice need to have a clearer understanding of what you can collect from insurance providers, and what then becomes their financial obligation. The website can have clear explanations, and you can also provide a reference sheet at the point of check-in or check-out to outline their responsibility in the payment process. A closer coordination between patient and office personnel can help clear up many of the misunderstandings regarding exactly how the medical claims and payment process works.

Facilitate Patient Payments

Make it easy to pay and patients are more likely to oblige. Let patients easily pay outstanding balances online with Quick Pay.

Key Metrics for 2022 Billing Practices

Net Collection Rate

Your net collection rate measures how effective your practice is at collecting maximum reimbursement for services provided. It reveals how well your coding and submission processes work, and then shows how well your practice collects any remaining balance from patients. A poor net collection rate indicates that your practice is not performing well at maximizing revenue flow.

Pending Accounts Receivable

A private practice needs to be aware of how much money it can expect to receive in the coming months. This is data that decision-makers can use to project the practice’s ability to meet upcoming financial obligations. It also indicates how well the practice is doing in the collections area, as revenue can be compared across quarters. The effectiveness of new or reinforced billing processes and collection methods will be seen in this metric.

Days in Accounts Receivable

While the pending accounts receivable metric shows the amount of money that is outstanding, the days in accounts receivable metric indicates just how long it takes your office to receive payment for the services it has provided. According to the American Academy of Family Physicians, 30 to 40 days is the target metric. If a significant percentage of your account receivables fall into the 90 to 120 day range, there is a problem in your billing and collection process.

Patient Flow Analysis

One surprising recommendation in Physician Practice’s recommendations for improving back-office billing strategies is patient flow analysis. This analysis identifies ways to increase practice revenue by ensuring a smooth flow from check-in to exam room. A better process maximizes office efficiency and matches provider scheduling to patient availability. A slow patient flow indicates room for improvement in gathering and verifying insurance information and confirming patient appointments. An empty room or an idle provider do not contribute to overall revenue.

New 2022 Medical Billing Issue – Surprise Billing

On December 27, 2020, the No Surprises Act (NSA) was signed into law as part of the Consolidated Appropriations Act of 2021. The Act, which took effect on January 1, 2022, provides patients with financial protection against surprise medical bills. Although not aimed at the primary practice, per se, the provisions of the Act are intended to address unexpected gaps in insurance coverage that result in “surprise medical bills.”

As the reality of this new Act sets in, your practice might unknowingly provide services outside a health insurance network or refer patients for medical services outside a covered plan, which could lead to a “surprise” bill. These changes might require front-end staff to have a better understanding and talk-track with patients to clearly explain patient responsibilities and reduce instances of surprise billing. The American Medical Association™ issued a “Toolkit for Physicians: Preparing for Implementation of The No Surprises Act.” to explain some of the implications and responsibilities.

So, 2022, right? Will it be a wonderful year because of the bad years that preceded it, or will it be another terrible year? Fortunately, your independent practice has tools available that can be used to help take control of your financial future.

Healthcare Technology Solutions Designed By and For Independent Practices

Amazing Charts was founded in 2001 by a practicing family physician to help medical practices thrive. We have grown consistently since then by creating easy-to-use solutions for delivering patient care. Today, we offer a variety of additional capabilities designed to help independent practices succeed, including Electronic Health Records, Practice Management, Billing Services, Population Health and Remote Care. Call 866-382-5932 to learn about our products, schedule a practice consultation, and learn more about telehealth pandemic lessons that can help your independent practice grow.