How to Take Your Medical Billing to the Next Level in 2024

When evaluating software, look for the following key features:

• Automated claim scrubbing: Advanced software will scrub claims for errors and missing information before submission, reducing rejections and speeding up reimbursement.
• Eligibility verification: Automatic verification of patient eligibility, coverage details, and required authorizations saves billing staff tons of time.
• Robust reporting: Look for customizable real-time reporting on collections, rejections, denials, aging claims, coding accuracy, and other KPIs to pinpoint issues.
• Patient billing portals: Letting patients pay bills and view statements online reduces collection costs and call volume.
• EHR/PM integration: Software connected directly to your EHR and practice management system reduces duplication and claim errors.
• Rule-based auto-adjudication: Configurable rules enable clean claims to be automatically adjudicated without manual review.
• Analytics: Leverage practice analytics to find optimization opportunities and track KPIs.

Today’s top billing software offers automation, efficiency, and insight light years ahead of legacy on-premise systems. While the upfront cost is higher, a modern platform quickly pays for itself through staff time savings, faster payments, and reduced denials.

Patient portals to focus on implementing include:

• Online Bill Pay: Allowing patients to pay statements directly through a secure portal, storing payment information for future use. This reduces write-offs from missed payments. Include the ability to accept credit cards, bank payments, and HSAs/FSAs.
• Digital Statements: Emailing billing statements and allowing patients to access them through a portal reduces postage costs and prevents missed bills.
• Payment Plans: Offer automated payment plan options patients can manage online without staff involvement. This is especially useful for larger balances.
• Pre-Service Estimates: Give patients the ability to get cost estimates ahead of non-emergency services and pay their share upfront. This increases point-of-service collections.

As you evaluate patient portal options, look for fast implementation, intuitive interfaces, flexible payment options, and strong data security. With the right portal, you can cut invoice processing costs by 75% while getting paid 2-3x faster.

Key recommendations include:

• Conduct Internal Audits: Regularly audit a random sample of EHR chart notes and corresponding claim codes to uncover weaknesses. Look for missed codes, inaccurate levels and modifiers, and Abuse billing red flags.
• Provide Ongoing Staff Education: Require coders to complete continuing education on the latest guidelines and changes minimum yearly. Stress the impact proper coding has on revenue.
• Implement Encoder Software: Encoders check codes against coding rules, ensuring validity and bundling requirements are met. Cloud-based software covers updates automatically.
• Develop Internal Coding Resources: Create quick reference sheets highlighting required documentation, common binaries, modifiers, and billing nuances for high-volume or problem codes.
• Outsource Complex Cases: Leverage outsourced coding for complex cases like trauma, oncology, and pediatrics. This ensures proper coding while letting staff focus on more routine cases.

By combining staff training, attacking this process improvement, and utilizing encoders you can raise coding accuracy above 95%, putting you in the top-tier of billing services.

Solutions to consider include:

• Automated Verification Checks: Your practice management software should automatically verify referral/authorization requirements and apply them during scheduling. Flags notify staff if a valid auth is nearing expiration.
• Eligibility API Integration: Leverage APIs from payers to automatically pull eligibility, plan coverage, and authorization details directly into your PM and EHR system.
• Referral Management Software: Using dedicated referral management software centralizes authorization requests and tracking. Features like templates, unlimited user access, and digital request/response reduce administrative burden.
• Self-Service Patient Portal Access: Allow patients to check authorization status and obtain approvals through a portal rather than calling. Useful for procedures, labs, imaging, durable medical equipment, and medications requiring pre-approval.

Targeting the authorization process removes a common source of rejected claims. It also reduces appointment cancellation when missing approvals come to light after scheduling.

Options include:

• Direct EDI claims submission: EDI allows claims to be submitted directly from your practice management or billing system. This eliminates paperwork, provides faster confirmation of claim receipt, and speeds payment.
• Payer web portals: For smaller volume payers, submitting claims via their proprietary web portals can work well. However, it does require logging into multiple systems.
• Clearinghouse EDI submission: Clearinghouses act as intermediaries, taking claim data from your system and translating it to payer-specific EDI formats. They consolidate submissions to all payers.
• Dual paper and electronic submission: Use online methods as the primary approach but still print and mail paper claims as needed per payer requirements.

While EDI requires more setup, it automates the entire process, lowering administrative costs. Whichever route you take, minimizing paper claims is key to faster reimbursement.

Strategies to reduce rejections include:

• Claims scrubbing automation: As discussed previously, use software that scans claims for errors, inconsistencies, and missing data prior to submission. This flags issues for early correction.
• Data validation rules: Set up validation rules in your PM and EHR system to catch bad phone numbers, addresses, DOBs, SSNs, etc. in real time during data entry.
• Code edit checks: Your practice management system should confirm procedure and diagnosis codes are valid and appropriate through automated edit checks.
• Digital signature integration: Enable providers to digitally sign off on charts and claims, preventing rejections due to missing physician authorization.
• Attach supporting documentation: Provide relevant medical records, op reports, and other supplemental documentation with claims rather than waiting for payers to request them.

Fixing a rejected claim and resubmitting delays payment by 2-3 weeks, typically. Preventing rejections through upfront error checking and data validation is well worth the effort.

Key features to look for include:

• Customizable dashboards for each user role (manager, biller, coder, etc.)
• Interactive charts and graphs
• Drill-down capability to transaction-level details
• Exporting to Excel/CSV
• Real-time data visibility
• Scheduled report delivery
• Analytics focused on revenue cycle optimization

By analyzing trends over time, benchmarking against goals, and spotting outliers, you gain actionable insights to drive results. Applying analytics to correct inefficiencies yields a significant ROI.

Tips for improving staff skills include:

• Require a minimum of 10-20 hours of continuing education yearly to maintain certification
• Conduct regular internal training on evolving regulations, payer requirements, and system features
• Reward continuing education completion and coding certifications
• Send staff to local conferences and workshops in your specialty
• Provide onsite education on customer service skills and stress management

Keeping staff skills aligned with the latest regulations, codes, and system functionalities ensures accurate claim submission and approval. It also improves morale and retention. Continuing education demonstrates your commitment to helping staff advance their careers.