How to Tell If Your Medical Billing Department is Well Managed

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How to Tell If Your Medical Billing Department is Well Managed

By MGSI – Medical Group Services (30+ days ago)

There have been multiple occasions where I have met with physicians, practice managers, practice administrators or billing managers who want to know if they are capturing every dollar possible from their billing efforts. More often than not, physicians do not have a “clear” picture or understanding or how their medical billing & collections department is doing or how the overall practice is doing financially. Below are 10 questions every practice should be prepared to answer for the overall financial health of the practice. If you answered ‘No’ to 2 or more of the below questions, you are a candidate for outsourcing your medical billing process.

1. Does your practice base its fee schedule on a quantifiable process or is it determined in a random manner?
a. How do you set up fee schedule for each CPT code?
b. Have you researched your payer mix and reimbursement rates?
c. Are you capturing the highest possible reimbursement rate?
d. Do you base it on a percentage of the current Medicare allowable?
e. Do you track if your payers are paying you based on your contracted rates?

2. What are your lag times? Identify the times between date of service and
a. Date of charge entry - how long does it take your billing department to enter office charges? Hospital charges?
b. Date of claim submission - how long does it take your staff to transmit claims?

3. Do you perform a bi-monthly or monthly charge-capture audit to insure that all types of charges are captured?
a. Do you track missing tickets (encounters)? Need to set up internal audits within your medical billing department to ensure that all services being rendered by provider or extender are being captured and billed out. Same is true for hospital charges, skilled nursing home visits, etc.
b. If you are a specialist- do you know who your top 3 -5 referring providers are? Do you benchmark referrals for marketing or public relations?

4. Do you collect and monitor data regarding reasons for denials and use the results to train your medical billing department, front desk staff, check out staff, providers?
a. Do you know what type of denials you are generating and why?
b. Is your billing department handling denials timely?
c. Is your billing department handling appeals processes timely?
d. Do you have time filing issues?
e. Are you using all the services offered by your clearinghouse? -- acceptance and rejection reports, transmittal codes, payer ids, claims errors, etc.

5. Does your business (billing) office share the reasons for electronic rejections?
a. Are they training the front desk staff when there are errors in patient demographic data entry?
b. Is the coding department informed of coding rejections, bundling issues, lack of modifiers, etc?
c. OR, does your medical billing staff correct the errors herself/himself because it’s easier and faster?

6. How do you monitor both categories or write-offs: contractual adjustments vs. non-contractual adjustments?
a. How often to you monitor your billing department’s adjustments?
b. Do you define your write offs?
c. Do you track the different type of write-off? EI: bad debt, sent to collections, adjustment due to lack of authorization, adjustment due to no referral, adjustment as not covered service, adjustment as non-participating provider, etc.

7. How often is a credit balance report run?
a. Does your practice comply with state and federal laws regarding credit balances?
b. Do you have a policy in place to handle patient refunds?
c. How timely are refunds processed?
d. Is your credit report worked on monthly?

8. How do you prioritize your outstanding accounts receivable or aging reports? How is your A/R report(s) worked by your billing department?
a. Is it by balance due (high to low)?
b. Account type?
c. Payer type?
d. Date claim submitted?
e. Alpha?
f. Date of service and age of account?
g. When refilling claims- does your original file date remain on system or does it get purged with new refile date?
h. Is every account on your report “touched” on a monthly basis?

9. Have you recently assessed your current billing statement effectiveness?
a. Is the front desk calling to verify coverage?
b. Is the front desk collecting co-payment dollars, deductibles, patient dues?
c. Are ABNs done correctly?
d. Are you offering payment by credit card? Online?
e. How many statements are sent to the patient?
f. Do you have a “minimum” amount due set up in your practice management software before a statement is generated?

10. Is your billing staff cross-trained?
a. If a billing staff member is out, on vacation, or long term illness – are the other members able to continue the medical billing and collections process seamlessly? Or is the practice’s cash flow impacted?

About Author:
Niurka Moreno is a successful healthcare professional with 20+ years experience. She has demonstrated continuous growth, achievements, and leadership in practice management and Revenue Cycle Management.

She is specialized in maximizing the efficiency and profitability of physician practices nationwide through the development of advanced RCM and technological solutions.


Related Categories

healthcare billing services - medical billing services - medical billing companies - medical billing company - provider billing - medical billing - medical billing and collections - medical billing companies in florida - medical billing florida

Contact MGSI – Medical Group Services
2810 W.St Isabel. St , Suite 201, , Tampa, Florida, 33607, United States
phone: 1-813-890-8004 fax: 813.884.8355
http://www.mgsionline.com/
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