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Billing, Reimbursement and Claims: How to Drive more Revenue

Successful medical practice reimbursement revenueWe’ve written before about how providers can grow their top line with a thoughtful marketing plan, but gaining new patients and expanding the services you provide to existing ones is only part of the revenue equation. It is also essential to make sure that you are capitalizing on each encounter with sound billing, reimbursement and collections routines. Here are a few habits of highly successful practices:

Make sure to file secondary insurance claims

A survey by Greenway Health reveals that 41% of secondary claims are never filed. That’s a huge amount of revenue being left on the table.  In most practices, the administrative overhead necessary to file secondary claims will be dwarfed by the increase in income.

Use the right codes

The transition to ICD-10 has made coding much more complex. If you are using the wrong codes for services performed, you might be undercharging. It is worth your time to audit the codes for the services you perform most frequently.

Make sure patients know what they owe

Further survey data shows that 68% of patients do not receive collection letters from their care providers. To reduce the impact of unpaid bills on your bottom line, implement and follow a disciplined collections plan. You may decide to offer flexibility to some patients or to forgive some debt, but this should be done thoughtfully, not as an oversight.

Update your payer fee schedule

It is essential to update your payer fee schedule annually and to audit payments. You’ve provided the service, make sure you are getting reimbursed appropriately.

Turn unpaid interactions into paid ones

Some of the work you do is not reimbursable by providers, but in some cases, simply changing the method of care delivery can lead to billing opportunities. For example, follow-up calls via phone are not usually reimbursable, but in many cases, video follow-up visits are.

Verify reimbursement eligibility prior to the visit

You want to be sure that the patient has coverage and that the payer will reimburse you for the type of encounter you have scheduled. Reimbursement policies for telemedicine, for example, vary by state and provider. Choose technology that helps you verify eligibility before services are provided.

Collect copayments

Patient copays alone make up roughly 20% of a doctor’s revenue. Yet, according to a study by the Medical Group Management Association, most physicians only collect a measly 60% of patient copays. You can avoid this by making your, “No copayment, no visit,” policy clear to patients and training staff to hold the line on collections. It is also helpful to include the copayment amount along with appointment reminders.

These are a few simple ways you can increase your revenue without adding much additional cost. If you find that your practice still struggles to pull in all the revenue it has earned, a third party billing service might be the right move for you.