Revenue leakages and medical billing in the healthcare industry can lead to significant losses due to long payment cycles. These involve the right medical coding insertion, medical billing process, and increasing claims for payers to get reimbursed on time. Some notable loopholes must be tracked to provide stability to your healthcare business and ensure a steady cash flow.
Taking a proactive approach not only helps you to maximize your cash flow but also prevents problems. Therefore, it is necessary to understand the intricacies of the medical billing system to ensure better reimbursements_ so you become able to deliver quality care to your patients.
High-touch relationships and custom-tailored medical billing solutions may also help you to achieve your financial goals and remain financially independent. Your medical practice will not get paid if your staff doesn’t file the claims correctly. It is crucial to make sure all codes are correct and you meet all the industry standards including state/federal regulations, insurer contracts, and current healthcare laws. Failure to stay updated with medical coding & billing regulations will only lead to delayed submission, errors, and eventually revenue loss.
Healthcare organizations should delegate the job of keeping up with regulations, deadlines, and rules to ensure compliance. Your billing process can remain efficient and accurate when you stay on top of changes in the healthcare industry.
Stop the Downward Flow of Revenue
The payer reimbursement keeps going down and the expense of doing business keeps going up. Your healthcare business can’t afford to lose a significant amount of cash through inefficient medical billing services. But, if you are utilizing outdated & inaccurate medical billing and coding practices you will be at the drastic edge. There are the following four key business goals that an internal medical billing audit accomplishes.
● Improve revenue integrity.
● Improve transparency.
● Maintain/achieve high-quality information and data integrity.
● Satisfy compliance plan requirements.
● Business process improvement that provides for reliable/more consistent billing and coding evaluations.
Make Your Audit Successful
Auditing evaluates whether the documents retrieved are accurate & complete with supporting data_ and whether the facility can retrieve particular data promptly in the encounter sample. It shows how efficiently your EHR system can retrieve the supporting documents and specified records in a given duration. Creating more records than demanded is considered a fail. To put it in simple words. That’s a failure when the records are incomplete if the date of service is not what you requested for the correct patient. Audits can help you to catch viable compliance problems. Otherwise, it could land you penalties with Medicare if you’re credentialed and impact your bottom line as well.
Audit To Make Enduring Improvement
Performing regular medical billing audits is useful for your organization- no matter what is your motivation. With this, you can boost the profitability of your business. Though billing audits help you find inefficiencies that are costing you money. These are initially compliance measures to check that your medical billing services are compliant and efficient. It depends on different variables_ how often does your medical practice perform audits? It may require more frequent audits for problematic specialties and a high volume of cases. The right way is to conduct external audits yearly and internal audits every quarter year to validate internal audit consistency. Following are the things to audit records that involve;
● Inaccurate or erroneous coding.
● Accuracy.
● Inaccurate sequencing of diagnosis codes.
● Missing codes.
● Completeness.
● Incomplete data for a provider or a patient.
● Down-coding & up-coding.
● Correct assignment of procedural.
● Correct use of modifiers.
● Diagnostic.
● DRG assignments.
Make sure to audit Medicaid and Medicare encounters separately while performing a medical billing audit.
Look for Fraud
Incorrect billing and coding result in denials, overtime for staff resolving improper payments/rejections, and partial reimbursements. It leads to serious challenges such as fraud. Fraudulent medical billing & coding includes;
● Down-coding & up-coding.
● Billing twice for the same service.
● Coding for services not rendered.
● Incorrect diagnostic codes, billing codes, dates of service, units of service, or
service providers.
● Billing for services not rendered to consumers.
● Unbundling a single procedure.
● Upcoding an item on the claim is a more complicated process than the one given.
Results of violating the FCA are severe. For instance, if the CMS doubts your claim is up-coded. Civil penalties for violating the False Claims Act (FCA) may involve penalties up to $22,927 per false claim filed_ and as a result of false claim recovery of thrice the number of casualties sustained by the authority.
Figure Out Missed Opportunities
Missed charges may lead to a large amount of revenue loss. According to the CMS report, about 30% of claims are either denied or ignored when they are sent to payers. While 60% of them are never appealed thereby leading to the revenue loss for that facility. Such types of mistakes happen when the codes are not allowed for the rendered services. Moreover, under-trained staffing, poor denial management protocols, and lack of discipline in collecting patient receivables are other factors that contribute to revenue loss. At that point, Electronic Health Records can ease your problem. It can help you reduce medical billing inaccuracies.
Analyze the Results
After completing auditing, analyze the final results. Measure the dollar amount by the significant loss in reimbursement for inaccurate medical billing. Which also leads to an increase in appeals, rejections, and scam crises in most cases. Identify areas of improvement and address them on time to ensure financial viability. Moreover, once errors are identified providers must perform internal medical audits on a continuous basis.
Follow Protocols & Stay Educated
Hence, make sure your administrative team adheres to the latest industry regulations and is well-trained to establish billing & coding procedures. It is integral that staff have hands-on experience in medical billing. Besides, even if your staff cannot follow the new trends then the best coding & auditing protocols are worthless. Practices must train and educate them on changes within the healthcare industry.
Best Medicine Is Prevention
Adopt proper medical billing and coding practices to keep tracking the reasons for the inaccuracies and inaccurately coded encounters. It will help shield your facility against future denials by enhancing awareness among employees about preventable errors. In addition to this, the key to increasing your practice’s overall financial health is to prevent billing & coding errors. Professional medical billing services ensure greater profit potential for your practice and can lead to increased payments for the services provided.
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