Three Steps to Maximize Your Reimbursement

The goal of any healthcare practice is to provide excellent patient care. To do that, you must optimize your revenue cycle and increase your medical billing efficiency. Here you can discover the three most important steps to maximize reimbursement and improve your practice’s financial well-being.

  • Improve Claim Management

The insurance providers are strict about billing procedures and claim practices. That’s why even minor billing errors can result in denied claims. That could lead to the cycle of editing, resubmitting, and rejection, which requires time and resources. In addition, your reimbursement can take months.

You need to be careful and double-check your claims before submitting them. Avoiding errors in the first place is the best way to minimize problems and maximize reimbursements.

The most common errors include:

  • Incorrect insurance information
  • Incorrect provider information
  • Incorrect patient information
  • Inadequate documentation
  • Duplicate billing
  • Coding errors
  • No Explanation of Benefits for denied claims

You need to differentiate between rejected and denied claims and address them accordingly. The most important difference is that a rejected claim can be edited and resubmitted. On the other hand, a denied claim requires going through the appeal process before resubmitting, which is more complicated and financially straining.

The best way to prevent denied claims is to ensure all the information is correct. If your claim gets rejected or denied, address them immediately.

  • Minimize Coding Errors

Incorrect, missing, or mismatching codes are a nightmare for any healthcare practice. Luckily, most of these errors get caught before they become an issue. However, you need to keep an eye out for some of the most common problems, such as upcoding or undercoding.

Upcoding occurs when a provider uses a code for a more expensive procedure instead of a correct one. It usually occurs because of miscommunication, but it is considered a crime if done intentionally.

Undercoding occurs when a provider fails to list the codes for all services provided to the patient. That results in a loss of revenue.

Always double-check codes before submitting a claim to avoid problems.

  • Create a Clear Process for Claim Collection

A detailed plan on how your practice handles claim collection is vital for maximizing reimbursements. You should create a step-by-step checklist that clarifies all involved actions and improves your revenue cycle efficiency. 

This process is usually complex and time-consuming initially, but it can help you in the long run. It can help maximize your reimbursements, collect more quickly, and minimize friction in your revenue cycle.

Here are some steps your collection process should involve:

  • Collecting patient information

You should check a patient’s photo ID on the first visit and record their personal information. You can use this information to send them bills for received services.

  • Establishing clear terms

You need to be transparent about your patient’s responsibilities and what services are not covered by their insurance. That should clear up any misunderstandings and prevent payment problems.

  • Asking for consent to leave voice messages

Sometimes billing details change, so you should be able to notify your patients about it straight away. Ask them for permission to leave voice messages, and let them know as soon as something changes.

  • Confirming personal information 

You should check your patient’s information regularly. Ask them about any changes, particularly about their address and phone number. That will help you avoid wasting money sending mail to the wrong address.

  • Verifying insurance 

You should verify the patient’s coverage before each visit to prevent insurance problems and denied claims. An automated system can help you do this in an instant.

  • Presenting payment options

You need to be transparent about the necessary payments and what options patients have to cover them. Let them know whether you accept cash, credit cards, or checks and if you have available payment plans.

  • Collecting payments upfront 

Instead of chasing payment down after you provide services, you can require upfront payments and avoid these issues.

  • Billing notifications

Create a letter system to notify your patients about the deadlines, like when their bills are due, overdue, or about to be sent to collections. Physical letters can be a better tool than leaving voice messages, but we recommend doing both. In addition, send several reminders to ensure they are not missed.

You can maximize your income by creating a collection process that ensures all claims get paid.

Where to Start Optimizing Your Reimbursement?

The three steps above are a great start if you’re looking to optimize your reimbursements. However, the best initial steps depend on each practice. That’s why it is vital to track your performance, identify problems, and address them immediately. Good reimbursement starts with an efficient revenue cycle.

Analyzing your revenue cycle can help you discover what actions have the biggest potential to maximize your reimbursement.

Maximizing Reimbursement in Houston, Texas

Peregrine Healthcare helps practices boost their reimbursements through various revenue-optimizing processes. We offer multiple services to maximize your practice potential and improve income flow. 

Contact Peregrine Healthcare to receive a personalized strategy on how to maximize your reimbursement.

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