Maximizing Reimbursement in Houston: 3 Key Strategies

Every healthcare professional is devoted to bringing the best medical care to their clients. In order to do so, though, multiple aspects of their practice must align: staffing, equipment, and RCM. Revenue Cycle Management, however, requires very specific expertise and strategies. In the pursuit of maximizing reimbursement to be able to offer patients top-of-the-line service, we are sharing 3 key strategies

3 Keys to Maximizing Reimbursement in Houston

Accurate reimbursement is the backbone of a medical practice’s revenue. As such, it is important to stay up to date in terms of how to maximize it. While the coding and healthcare industry landscape keeps evolving, we have compiled three key strategies to weather its complexities. Here are 3 strategies to maximize reimbursement:

Related insight: The Best RCM Tools 

1. Before Anything Else, Preparation Is the Key to Success

The process of getting reimbursed for your medical services begins before your first patient comes in —and with your patients in mind.

When your patients walk through your doors, they must do the least possible, so that they can focus on their health alone. Similarly, making their process easy and smooth also benefits you. You are setting your practice up for success. How exactly? Here is a comprehensive checklist of everything you need to cover to be able to reap the benefits at the end of the billing period.

  • Streamlining patient registration and verification. It is a good idea to look into configuring a patient portal to collect patient information and verify their insurance coverage. Also, you might want to install automated insurance systems so as to check patient eligibility.
  • Training staff thoroughly on accurate patient information and service. This point should not be overlooked. The right training can prevent claim denials and coding and billing errors.

2. Maximizing Reimbursement through Coding

When billing patients and payers, diagnoses, procedures, and equipment translate into alphanumeric codes that help streamline the payment process (among other things). 

Here’s an example:

A patient visits their doctor with flu symptoms. Therefore, the physician examines the patient and orders a test. In this scenario, coding and billing would look something like this:

  • Diagnosis: The ICD code for “Influenza due to other identified influenza virus with other respiratory manifestations” is J10.1.
  • Examination: The time that the doctor spent evaluating the patient could be coded as 99213, “Established patient office or other outpatient visit, 20-29 minutes.” 
  • Lab tests: Likewise, the bill will include a test as code CPT 85027 (blood count, complete (CBC), automated).

As a consequence, the bill will reflect the services rendered through each code, which is reimbursed accordingly.

The example illustrates the importance of proper coding. However, coding is equally important and confusing. There are more than 10,000 codes, which virtually no healthcare provider can remember. To help with this task, we recommend hiring professional coders or outsource the coding to a knowledgeable healthcare consultant like Peregrine Healthcare.

Related insight: Maximizing Reimbursement through Coding

3. Maintenance is Essential: Schedule Regular Audits

Establishing periodical audits enables organizations to optimize their RCM processes and foster continuous QI (quality improvement). Furthermore, during audits professionals can identify strengths and where there is room for improvement. As a result, they can prevent multiple issues and also course correct where necessary. Ultimately, by maintaining an optimized practice and preventing issues, alongside with the financial aspect of the audits, healthcare providers save enormous amounts of time and money.

Related insight: 5 Ways in Which a Healthcare Audit Benefits Your Practice

Why Choose Peregrine Healthcare to Help You Maximize Reimbursement

Peregrine Healthcare offers comprehensive services to healthcare providers. As the professional extension of our client’s practices, we work together to maximize reimbursement and continuously improve their Revenue Cycle Management.

Some of the benefits of our services include:

  • A state-of-the-art revenue collection system. Our credit scoring system lets you predict which customers are more likely to repay and those that need additional help. This helps set up your practice correctly and avoid future mistakes.
  • Our systems support different payment options. By giving patients flexibility, you can have the peace of mind that they can always cover the fees.
  • Patient pay policies designed to improve reimbursement.
  • Get full access to our online portal to view real-time metrics. This way, you can compare your performance against industry standards.

Do not hesitate to contact us for more information and to learn about how we can tailor our reimbursement solutions to your needs.

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