7 Ways to Reduce Revenue Leakage in Medical Billing - PowerPoint PPT Presentation

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7 Ways to Reduce Revenue Leakage in Medical Billing


‘Revenue leakage’ refers to situations where a healthcare provider doesn’t receive insurance reimbursement for delivered services. You can reduce revenue leakage by adopting 7 tips shared in this article. – PowerPoint PPT presentation

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Title: 7 Ways to Reduce Revenue Leakage in Medical Billing

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7 Ways to Reduce Revenue Leakage in Medical
  • Revenue Leakage in Medical Billing
  • Revenue leakage refers to situations where a
    healthcare provider doesnt receive insurance
    reimbursement for delivered services. In such
    billing situations, accounts receivable remain
    unpaid for too long and eliminates the chances of
    payment recovery, even partially. Healthcare
    practices cannot afford to ignore their revenue
    leakage as its directly affecting their ability
    to smoothly run day-to-day activities. The good
    news is that providers can address many of the
    revenue leakage causes by identifying
    inefficiencies, improving their processes, and
    targeting improvement. In this article, we shared
    7 ways to reduce revenue leakage in medical
    billing, lets discuss them in detail.
  • 7 Ways to Reduce Revenue Leakage in Medical
  • Quickly Submit Claims
  • Your billing teams prime responsibility must be
    to submit insurance claims as soon as possible,
    ideally within 24 hours of the patient visit.
    Your billing team should be ready with all
    required details prior patient visit like patient
    demographics, insurance information, insurance
    coverage, patient responsibility, referral
    number, and prior authorization (if any). Once
    your coding team provides procedure codes and
    modifiers, you can submit

7 Ways to Reduce Revenue Leakage in Medical
claims quickly. When you quickly submit insurance
claims, it offers a lot of benefits like quick
insurance response, correcting rejected claims,
and reduced AR days. Every insurance company has
different timely filling limits starting with 3
months up to 12 months. Ideally, you should not
wait for such timely filing limits as a claim may
get rejected at any stage, and once it returns to
your desk, half the time is gone. Familiarize
yourself with the best practices that ensure
timely filing of claims like using billing
software filing fresh claims daily daily
checking of benefits verification (including
prior authorization) and rework on rejected and
denied claims. 2. Entering Correct Claim
Details Entering incorrect patient demographics
and insurance information is the prime reason for
claim rejections. Prime reasons for claim
rejection include the incorrect date of birth,
name or spelling, subscriber number, incorrect
zip code, and subscriber information. When the
claim is rejected, its stuck in billing software
and it does not reach the payers system until
its been corrected. To reduce such rejections,
you need to improve the patient registration
process. Each and every patients details need to
be crosschecked to verify their correctness.
There are several ways to crosscheck these
details. You can use the provider portal, or use
clearinghouse services. Some billing software
shares such benefits reports with a single click,
or you can
7 Ways to Reduce Revenue Leakage in Medical
directly call the insurance rep. These activities
will help to bring claim rejections as low as 5
percent while identifying prior authorization
requirements. 3. Crosschecking Insurance
Coverage Using eligibility and benefits
verification you can reduce your revenue leakage
to great extent. In the eligibility and benefits
verification process, the billing team will check
the patients eligibility for planned procedures
along with the patients overall benefits. If a
patient doesnt have active insurance coverage
then you can communicate with the patient for
alternate insurance. The eligibility and benefits
verification process also helps to find out prior
authorization requirements. Eligibility and
benefits verification provides you the assurance
that you will get paid for the delivered services
as the patient is having active coverage. 4.
Reduce Coding Errors Medical coding is the core
of revenue cycle management. Medical coding can
be challenging as coding guidelines get updated
constantly, plus coding guidelines slightly
change as per insurance company and state.
Frequent coding errors include using incorrect or
deleted codes missing modifiers or combination
codes lacking medical specialty-specific coding
experience, and under coding. Most practice
owners make the
7 Ways to Reduce Revenue Leakage in Medical
mistake of doing medical coding all by
themselves. In such situations, they tend to use
few procedure codes for all their patient visit.
Such activities will not only attract compliance
issues but also impact the practices revenue in
long term. Its a must condition to have a
certified, experienced medical coder who has done
coding for your medical specialty in your area.
Such a qualified coder will help you code
accurately and will also use modifiers whenever
applicable. You also need to invest in their
training to ensure that they are updated with
current coding guidelines. 5. Entering Accurate
Diagnosis Codes The diagnosis codes are
important because it provides a common language
for recording, reporting, and monitoring
diseases. The diagnosis codes support the medical
necessity for the service and tell the insurance
companies why the service was performed. It can
be the source of denial if it doesnt show the
medical necessity for the service performed. The
current version of diagnosis codes
i.e., ICD-10 comes with the basic requirement of
using diagnosis codes with the correct level of
specificity. You have to use accurate diagnosis
codes as using codes from the right family is not
enough, and might cause claim denial. To
eliminate such claim denials, healthcare
providers should share accurate diagnosis on
time. Your billing team can cross-verify the
correctness of diagnosis codes as certain billing
software and clearinghouse services also provide
such suggestions.
7 Ways to Reduce Revenue Leakage in Medical
6. Comprehensive Denial Management Denial
management is a strategic process that aims to
resolve problems leading to medical claim
denials. Denial management also sets up a process
that mitigates the risk of future denials. Not
working on denial causes is the major reason for
revenue leakage for any healthcare practice.
According to a recent survey report, the average
claim denial rate has increased by 23 percent
compared to four years ago. For medical
practices, this means unpaid services, resulting
in lost or delayed revenues, hurting the
financial health tremendously. The
comprehensive denial management process includes
steps like identifying the denial cause
resolving denials monitoring and preventing the
occurrence of the same denials. Your coders,
billers, AR team, and physicians should work
together to identify, resolve, monitor, and
prevent claim denials. 7. Ensure Provider
Credentialing All your physicians must be
medically credentialed to be reimbursed by
insurance companies. Every insurance company
wants you to get credentialed before you start
interacting with the patients. The credentialing
process validates that a physician meets
standards for delivering clinical care. The
insurance company verifies the physicians
education, license, experience, certifications,
affiliations, malpractice, any adverse clinical
7 Ways to Reduce Revenue Leakage in Medical
occurrences, and training. The insurance
companies might delay or refuse payments to
physicians who are not credentialed and enrolled
with them. Getting the documents completed on
time ensures that the new nurse or physician
youve employed can start offering services on
the first day. Provider credentialing is not
something to push off as the credentialing time
frame differs by state due to changes in
legislation and credentialing laws. Medical
Billers and Coders (MBC) is a leading medical
billing company providing complete revenue cycle
services. We are confident that the
above-mentioned ways will certainly help to
reduce revenue leakage for your practice. But you
need experienced and skilled billers and coders
to execute such strategies reducing revenue
leakage. Another challenge is to hire, retain and
constantly train such billing team, involving a
lot of investment. You can hire our medical
billing and coding services to eliminate your
revenue leakage. Our customized, cost-effective,
and medical specialty-specific services ensure
that you will earn more reimbursements while
staying compliant with payer-specific and
state-specific guidelines. To know more about our
overall revenue cycle services, email us
at info_at_medicalbillersandcoders.com or call us
at 888-357-3226.
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