A Plan of Action for Successful Medical Billing

Written by on August 29, 2014 in Features - No comments

TabletGroupWEBHow effective is your practice’s medical billing? The time has come to put a full stop to any negativity about the billing department! It’s a time for action. Making the most of the given team should be the goal of an administrator. Here is a possible plan of action to consider for increasing the efficiency and profitability of your practice’s medical billing.

A successful model is divided into three main parts.

  1. Process of a successful billing plan
  2. Understands the myths
  3. The key areas to address in the billing process

Part 1: Process of a successful billing plan

  1. Plan & strategize: Have you developed policies in regard to billing and insurance related matters? What is your plan of action for planned cases, surgeries, and unplanned admissions? Do you have pre–approval for planned admission?
  2. Data Entry: It’s important to identify your data entry points and to make sure that the trained staff performs the data entry on the appropriate software. If everyone is allowed to perform data entry, then what is your system to crosscheck the correctness of data entry?
  3. Expressive Communication: How does your team communicate with your end users? Do you have scheduled times to communicate new billing needs? How effective are your financial counseling sessions? Do you to do regular updates and do you communicate the changes to your patients?

Two other parameters to consider are feedback analysis and co-ordination while completing the entire billing cycle. It’s believed that man has the solution to all his problems, provided he looks within himself. The same is true for organizations, too. If practice/hospitals are to emerge victorious from this billing pit, then they have to strengthen, empower and encourage their team.

Despite of all the new software and procurements in medical billing and record keeping, billing is human centric. All administrators will agree with this fact,  there are several service delivery points in billing process and at each point it’s a human who makes an entry for the each and every service provided to the patient.

Part 2: The common myths practiced in the healthcare billing set-ups.

We have explained about the process for successful billing. There are few myths in billing which are dangerous and must be addressed if we want to have a successful plan of action for our medical billing.

  1. Billing is a discharge process: The fact is billing is an admission and pre-admission process which is only totaled at the time of discharge. The process of billing starts when the patient is at the admission department/receptionist. They should be addressed about insurance at this time and should be guided through the registration information.
  2. It’s the patient’s responsibility: The patient is only responsible to pay the amount. It is the medical facility’s role to let the patient know the amount to be paid, as well as to provide information to the patient regarding the insurance approval needs and the amount of co-payment.
  3. The patient is smart and well informed: People who have insurance are not always aware of a lot of things in their health policy. So it is the responsibility of the medical staff to ask and inform them about components like co-payments, excluded items cost, and out of pocket payments. It can be a routine job for the medical staff, but not so common to the patient. It is the responsibility of the staff to communicate and assist the patient so that they understand each and every query related to billing and payments.
  4. Brochures, websites and written material should suffice: Nothing can beat one-to-one communication between the patient and the staff. Speaking with patients over telephone or face-to-face will achieve the best feedback and allow a better chance for hassle-free payment from the patient. The mantra is “Expressive communication”.
  5. I’m just being professional: When you talk to the patient about the financial part of their visit, add that humane touch to it. Don’t just babble all the figures that you have scribbled, but explain in simple terms what each amount is for. That’s your job!
  6. Billing department is responsible for billing: This is a big myth which most medical staff believes. The billing staff only does the summation and segregation of the items under correct heading/sub-heading. Actual billing is done by the nurses or PAs. They are the people who add the components which are prescribed by the treating physician. So rather than blaming the billing staff for all errors, it’s better to understand that it’s the team effort which includes everyone to get an accurate final figure.

Part 3: The key areas to address in the billing process:

  1. Strong communication: Know who to address about the billing information pattern, who is the primary person responsible, what the best method of communication (in person, telephone, or email).
  2. Trained administrative staff: Administrative staff should have everything in writing and even the commonest information should be communicated to the patient.
  3. Prepare well before communicating: It is equally important to understand the medical facts about the patient before moving into a conversation regarding billing matters. The staff needs to modify the talks and may have to alter the time of discussion, if the patient is not comfortable or not in a condition where such aspects should be discussed.
  4. Team work for success: The administrative staff should be in touch with clinical departments, treating doctors, laboratory and radiology. This helps in understanding which patient requires new estimates and new insurance approvals.
  5. Double-check is important: A senior person should be appointed who can check the services given from the patient file to the amount billed, or not billed, for that service in the software for final accuracy.

It becomes easier to handle most billing situations, if these steps are followed. Many a time’s billing concerns can be avoided if administration handles the billing part smoothly.

By Nidhi Behl Vats
Freelance Medical Writer

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