Top 8 billing tips for health care practitioners

Whether you are a primary care physician, specialist or general care provider, the claims process is often administratively cumbersome and, if done poorly, can impede revenue and the growth of your practice. There is also sexuality.In fact, the data show that Nearly 15+% of claims Rejections cost providers millions of dollars in lost revenue. Denied claims trends have also increased over the last few years, with the denial rate nearly increasing. 17% since 2019. Therefore, it is important to manage the billing process.here sound health, we provide billing services and process thousands of claims on behalf of our practitioners. Below are some of the most common mistakes and tips found throughout the revenue cycle for providers to consider.

Tina Xiao, MBA
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1. Correct data entry and demographics at check-in: This seems rudimentary, but a surprising number of companies do not properly train their front desks on the importance of the first critical part of the billing cycle. Accurate data entry at patient check-in is very important. Collecting complete insurance and demographic information ensures proper claims and reduces the chances of claim denials. Be sure to collect a photo of the patient’s insurance card. And most importantly, get a photo of the back of your insurance card. The back of the card is often more important for billing purposes than the front.
2. Understanding payer contracts: Familiarize yourself with the terms and conditions of your contract with your insurance payer. Knowing exactly what your contract allows in terms of reimbursement rates, covered services, and billing guidelines can help prevent underpayments and denials. Healthcare providers often make claims for treatments that are permitted by license but not actually permitted by a particular payer’s contract.
3. Accurately Code Symptoms and Diagnosis: Avoid using symptoms as the primary code and use the proper diagnostic code for claims. Insurance companies usually require a specific diagnosis to issue a proper reimbursement. Primary care providers and their billers often make the mistake of coding symptoms and underlying diagnoses. For example, consider a patient who comes to you for help with a sore throat. If the diagnosis is strep throat, the coding must be for strep throat (bacterial or acute) in order for the payer to accept the claim.
4. Frequent and Proactive Rejection Management: Proactively follow up on denied claims and address issues promptly. Accumulated accounts receivable (AR) can complicate finances and reduce revenue. Analyzing denial patterns, correcting errors, and resubmitting claims correctly are important steps. In particular, don’t rely on biweekly or monthly batches to follow up on rejections. Best practice is to incorporate denials into your standard weekly billing and payment posting process. Additionally, the first time you receive a denial, your claims team should call the payer to understand the reason behind the denial. This will prevent the same error from occurring on future charges.
5. Thorough documentation: Maintain detailed and accurate medical records for each patient. Poor documentation impacts patient care and can lead to audit risks and billing disputes. Even if you have not yet been audited, there is always the risk of being audited in the future. And, of course, proper documentation is not only required under your payer agreement, but is also required as part of your state license as a healthcare practitioner.
6. Proper declaration of secondary insurance: Understand the proper procedure for submitting a claim to a secondary insurer. Be sure to check your Coordination of Benefits (COB) and which insurance is your primary insurance. If both policies claim not to be the primary policy, the claim can get stuck on his COB. In many cases, patients may not even be completely sure which is the primary. In such cases, it is important that patients contact their payers and verify their primary and secondary insurance. In addition, secondary payers are often required to first request physical documentation of the primary payer denying the claim and mail this physical description of the benefit along with the claim. While having patients have access to multiple insurance plans is ultimately a benefit to patients and providers, additional work is required to properly file claims.
7. Medicare Billing Compliance: When billing for services, follow the guidelines set by Medicare’s Local Coverage Determination (LCD). Failure to do so may result in the denial of your claim and the imposition of financial penalties. Make sure you know what kind of Medicare provider you are: Equal, Unequal, or Nonparticipating. If you’re a Medicare provider, make sure you know and have access to your Provider Transaction Number (PTAN). Contacting Medicare without a PTAN is notoriously difficult, but finding your number is equally difficult if you didn’t write it down when you received your Medicare welcome letter.
8. Access to insurance portal: Make sure you have access to the online portals of all the insurers we work with. This helps us track claims, verify entitlements, and communicate effectively. Most importantly, as the clinic owner, make sure you always have administrative access to the portal. Granting access to these portals to the billing and front desk teams is appropriate and necessary. However, be sure to deactivate employees as soon as they leave.

Implementing these billing tips can be a transformative step to improve the financial health of your primary care operation. These strategies can not only reduce billing errors, but also improve the overall patient experience. Integrating these practices into your operations means more than just managing invoices. You are laying the foundation for growth and success in your practice. In a situation where all aspects of healthcare are interconnected, mastering the art of billing is not only necessary, but a strategic advantage.

MBA Tina Xiao sound health, an innovative EHR and billing platform. Prior to Soundry, he was the Chief Operating Officer of WePay, an innovative payments company acquired by JPMorgan Chase & Co. He also expanded and launched several businesses at Intuit and QuickBooks.