12 Things A Practice Must Do To Maximize Reimbursements
The primary goal of a physician or medical practice is to provide quality healthcare services to its patients. Providing quality healthcare requires the establishment and maintenance of a well-trained team, from physicians, technical personnel to medical equipment, which all rely on the revenue that the institute generates.
Most healthcare services are covered by medical insurance, and the reimbursements received by an institute or practice from insurance providers are what generate their revenue. Hence, to make a practice successful the secondary goal must be to maximize their reimbursements.
Here we list 12 points that a physician or an institute should focus on to maximize reimbursements.
Table of Contents
1. Establish a process
It is important to establish a step-by-step process for any claim collection process. A printed form with a checklist containing all the steps like patient information and billing can be made to avoid errors that will lead to claim denial later on.
2. Updating Fee schedule
The fee schedule must be reviewed every 6 months or year before renewing your contract with your insurance company. You should always review and cross-reference the claimed fees with the standard allowed rate to avoid under-collecting. This will also affect the reimbursement you receive.
3. Proper coding
Codes are used while billing for the services provided to the patients. The diagnosis, procedure, and services provided to the patient are translated into standard codes and then used for billing. There can be errors like non-specific diagnosis, incorrect coding, missed coding, upcoding, and under coding. This can cause your reimbursements to be delayed, denied, or partially paid. So the person handling coding and billing should have good medical knowledge and be able to work smart in referencing the patient’s information and medical codes.
4. Claim management
Insurance companies have very strict regulations while reviewing the filed claims. Many claims are rejected because of incorrect patient information, incorrect provider information, coding issues, or other missing information. You should always double-check the claims before submitting them to avoid the time and effort that will be wasted in editing and resubmitting the claims.
5. Denied or rejected claim management
When a claim contains coding errors, an incorrect insurance number, or terminated patient policy, the claim will be rejected. Insurance companies have very strict regulations while reviewing the filed claims. Many claims are rejected because of incorrect patient information, provider information, coding issue, and poor or missing documentation. You should always double-check the claims before submitting them to avoid the time and effort that will be wasted in editing and resubmitting the claims.
6. Tracking performance
Being updated with the changes in healthcare regulations is a way to increase performance. You should always keep track of the yearly revenues, find out the reasons if it is increasing or decreasing, and stay abreast of the changes in the coding and billing processes. It is better to conduct team gatherings to discuss the commonly encountered issues and ways to solve them. It saves the time required to communicate with each team member when an issue presents or changes occur.
If you are relying on temporary staff for coding/billing and if you often find errors and delays in claims, it is best to switch to outsourcing. Outsourcing your medical coding and billing to specific dedicated companies will help in the timely accurate filing of claims, they will take care of denied and rejected claims. They will have the best tools, recent regulations, and save your time and labor expenses. When this aspect is handled by a billing partner like Practolytics, you can solely focus on patient care.
8. Increasing patient flow
For your practice to be successful, increasing your patient flow will act as a major factor. You must focus on giving the best service and maintaining a good relationship with your patients that will help gain their confidence. This will help in follow up visits and internal patient referrals.
Marketing is a way to reach out to people about the services you provide. You can reach out to a large group of potential clients via online and offline marketing.
Increasing your online presence through various social media platforms, websites, and advertisements is another important way to increase patient flow. Patients nowadays tend to look for healthcare centers with good online reviews to seek medical help or through other patient referrals.
As for offline marketing, distributing leaflets, business cards, internal patient referrals, physician-physician patient referrals, and organizing informative sessions in your community, help in increasing your patient count and overall revenue.
10. Patient collection
Healthcare services can be expensive depending on the complexity of the diagnosis and treatment. When you attend a patient and if they require any intervention that their insurance might not cover, you should always ask them how they plan to pay and present them with payment options, financial aids, and alternative treatments.
11. Review insurance contract
Insurance reimbursements are the main revenue source in almost all medical practices. Always review your contract before renewing your contract. You might need to look out for fee schedule changes, services covered, and any changes in coding, billing, and claim filing procedures. When you don’t review in time, you might end up underbilling for your services that can lead to fewer reimbursements.
12. Insurance verification
When a patient comes for medical help, always take a quick look at their insurance eligibility before providing any care. When you fail to do so, you might get left with an unpaid claim by the insurance company or the patient might not be able to pay their bills on time. This is another issue which if happens often affects the revenue of your practice.
Any physician or a healthcare center when starting a practice puts in a lot of time, effort, and financial investment to establish it well in terms of both quality and quantity. You need not only hard work but also smart work to generate satisfactory revenue to keep the practice healthy and running. Hence, it is important to find ways to increase your reimbursements in return for the service that you have provided. Speak to our experts at Practolytics who will walk you through every step of the revenue cycle and also help you understand what best one can do to keep your practice revenue consistent and healthy.
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