Essential Behavioral Health Billing Guidelines

Behavioral health billing can be a complex and time-consuming task for healthcare organizations. However, it is essential for your organization’s financial health and sustainability. Our guide will discuss important behavioral health billing guidelines, common pitfalls to avoid, and tips for improving your billing process and reducing denials.

Why Is Behavioral Health Billing Important for Your Organization?

Behavioral health billing is essential because it ensures you receive reimbursement for services rendered. 

Maintain cash flow

Accurate and timely billing is crucial for maintaining cash flow and ensuring the financial stability of your organization. Additionally, behavioral health billing services can help you to comply with regulatory requirements and avoid potential audits and fines.

Improve patient care

Proper reimbursement for behavioral health services can also help improve patient care access. When healthcare organizations are not reimbursed for services provided, they may need to limit the number of patients they can see, reduce their services, or even close their doors. These obstacles can be especially problematic in behavioral health, where access to care is already limited, and demand for services is high.

Track patient care trends

Behavioral health billing services can also help you identify and track trends in patient care. Monitoring these trends helps to assess your organization’s performance and allows you to make necessary adjustments accordingly. Additionally, it can help track the cost of care, the time of service, and the utilization of services, which can be beneficial in budgeting and financial forecasting.

Common Pitfalls to Avoid With Behavioral Health Billing

Failing to code services and stay updated on guidelines

Poor coding practices can result in denied claims and lost revenue. Another risk is not staying current with billing guidelines and regulations, which can lead to denied claims. Failing to promptly and effectively follow up on denied claims can tighten your organization’s cash flow.

Forgetting to confirm patient eligibility

Another pitfall to avoid is failing to confirm that the patient is eligible for services. This can happen when there is a change in the patient’s insurance coverage or when the patient is not aware of their coverage, which places the burden of the cost of care on the organization.

Failing to verify pre-authorization requirements

Failing to verify pre-authorization requirements with insurance payers or not obtaining pre-authorization when required can lead to denied claims and financial loss for your organization. 

How to Handle Claim Denials

When a claim is denied, always review the reason and take action to correct the issue. These initial first steps may include resubmitting the claim with corrected information or appealing the decision. It is also important to track denied claims and identify patterns or areas where your billing process may need to be improved.

Having a system in place for tracking and reviewing denied claims can help organizations to identify trends and patterns in denied claims, which allows them to improve and make necessary adjustments accordingly.

For example, if a large number of claims are denied for a specific code, this may indicate that the billing staff does not have adequate training on the use of that code; or, if claims are frequently denied due to missing documentation, your organization may need to review its documentation policies and procedures.

It’s also important to have a system for follow-up and appeals for denied claims. Partnering with a third-party behavioral health billing company can assist with this process.

Tips for Improving Your Billing Process and Reducing Denials

To improve your billing process and reduce denials, consider partnering with a team that utilizes behavioral health billing software. This software can help to automate many of the tasks associated with billing and ensure that all relevant information is captured. 

Implementing software will enable your team to manage billing more efficiently, eliminating the need for manual processes, which can slow down the process and lead to mistakes. Automated systems can also ensure that all relevant information is captured.

Using the Correct Behavioral Health CPT Codes

Coding services correctly is essential for reimbursement. Correct behavioral health CPT codes ensure that insurance companies understand the nature and scope of services provided. It is important to familiarize yourself with the most up-to-date behavioral health CPT codes and ensure they are used consistently. Using the right behavioral health billing codes can also help you track the organization’s performance and identify any areas that may need improvement.

Outsourcing ensures that your organization uses the correct codes and complies with all relevant regulations. Behavioral health billing companies have experts who are well-versed in the latest billing guidelines and codes and can assist with coding, billing, and reimbursement.

At Coronis Health, our revenue cycle management (RCM) team specializes in behavioral health billing. We stay abreast of the best practices to ensure behavioral health facilities improve revenue and remain financially independent. We provide end-to-end RCM so our clients can focus on what matters most: providing the best care possible to their patients.

Contact us today to schedule a free financial health consultation. We find missing revenue in 95% of our audits. Find out how we can help your behavioral health center thrive.

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https://www.coronishealth.com/blog/essential-behavioral-health-billing-guidelines/

Why Outsource Your Orthopedic Medical Billing Services?

For orthopedic facilities, a solid revenue cycle management process is crucial to financial success. With complex clinical needs and medical billing, you need a billing team with a thorough knowledge of the nuances in orthopedics and expertise in the specialty’s billing and coding. Outsourcing medical billing services is the best solution to achieving your bottom-line goals.

The Benefits of Outsourcing Your Orthopedic Medical Billing Services

When you find the right partner, outsourced orthopedic medical billing services offer the following advantages:

• Provides access to orthopedic billing expertise – orthopedic billing professionals have the knowledge and understanding of the complexities of orthopedics as a specialty, easing your efforts to train your staff and update your systems. Orthopedic billing has its share of perplexities, and coders need specific credentials, like the Certified Orthopedic Surgery Coder certification. Working with billing experts with years of experience in orthopedics is essential to mitigate coding errors and compliance issues that affect your collection process and revenue.

• Lowers costs while improving patient care – outsourcing billing can be cost-effective. It prevents your in-house team from being overburdened with work and reduces the overall cost of maintaining office space and regular staff training. By having professional coders who are focused solely on billing, your staff can devote their time and effort to tasks they are more experienced at, such as providing valuable patient care.
• Reduces coding errors – certified coders and orthopedic billing experts appropriately use the correct ICD, CPT, and modifier codes. Submitting the correct documentation prevents practices from facing costly denials.
• Faster collections and more aggressive follow-ups – since coding and documentation are accurately done the first time, reimbursements are quick. Your outsourced billing team also meticulously tracks each claim until you receive your payments. They help get you the last dollar you deserve.

The Costs Associated with In-House Medical Billing

Maintaining an in-house medical billing team is more costly than you think. Common costs include:

• Overhead expenses – in-house medical billing requires capital investment in infrastructure, recruitment, salaries, benefits, and technology.
• Liabilities – an in-house billing department is susceptible to errors and general employee neglect. Discarded bills and forms and unappealed claim denials affect your cash flow and cost you more expenses in the long run.
• Support issues – if you only have two or three employees handling billing, your operations, including cash flow, can be stalled. When even just one employee goes on vacation or gets sick, your billing department is unable to fully function.

The Importance of Choosing a Reliable and Experienced Medical Billing Partner

Not all orthopedic medical billing companies are created equal, and some may not offer the services you need. It is necessary to plan carefully and choose a reliable partner that meets your needs and goals – after all, the billing company you choose serves as an extension of your business itself.

Before partnering with an orthopedic billing company, make sure they have the following:

• Expertise in orthopedic billing & medical coding services – orthopedics comes with its own billing requirements and challenges. Your billing partner must have expertise in your specialty to ensure accurate billing and coding and faster claims processing.

• Reliable support – your partner should never leave you hanging. Choose a company that is with you every step of the way and provides support whenever needed. 
• Excellent customer service – with reliable services and support, you can rest assured you can handle and overcome issues and stay on track to reach your financial goals.
• Transparency – your partner must provide real-time access to reports and any form of data you need.

What to Expect From Your Orthopedic Medical Billing Services Partner

With an orthopedic medical billing services partner, you can expect a comprehensive array of customized services, including:

• Medical coding
• A/R and denial management
• Electronic health records (EHR) system installation
• Financial reporting 
• RCM solutions

Overhead expenses – in-house medical billing requires capital investment in infrastructure, recruitment, salaries, benefits, and technology.

• Liabilities – an in-house billing department is susceptible to errors and general employee neglect. Discarded bills and forms and unappealed claim denials affect your cash flow and cost you more expenses in the long run.
• Support issues – if you only have two or three employees handling billing, your operations, including cash flow, can be stalled. When even just one employee goes on vacation or gets sick, your billing department is unable to fully function.

Coronis Health offers all these services and more to ensure every client has the support they deserve to run a successful orthopedic center.

How to Get the Most Out of Your Partnership

Your partnership only becomes a strategic alliance when you consider the following practices:

• Understand that it’s a partnership – outsourcing means teamwork and collaboration that require full cooperation to achieve goals.
• Evaluate your needs first – determine your internal business needs to help align your goals with your partner’s and design the best action plan.
• Define the scope of your partnership – clearly define what services you need, so tasks don’t overlap and you don’t pay for services you don’t need.
• Establish clear and consistent communication – miscommunication is a stumbling block that can interfere with your processes. With clear communication, you can work seamlessly.

Contact Coronis Health to learn more about our orthopedic medical billing solutions and other physician services or to request your free financial checkup. 

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https://www.coronishealth.com/blog/why-outsource-your-orthopedic-medical-billing-services/

What Modifiers Are Used for Behavioral Health Billing?

Modifiers are used in healthcare billing to indicate a procedure or type of service provided in addition to an evaluation and management service or to identify the level of a provider. A modifier code is typically two characters (numbers or letters) that are added to the procedure codes in the claim. Modifiers in behavioral health billing are just as important as in medical billing. They are essential to ensure that reimbursement is captured at the highest level possible. 

Maintaining a clear understanding of these modifiers and their intricacies can help optimize your documentation and improve the performance of your behavioral health billing process.

What are behavioral health billing modifiers?  

Behavioral health billing modifiers are codes added to a claim for reimbursement for behavioral health services. These modifiers indicate specific circumstances that impact the way a service was performed or the patient’s condition and are used to determine the amount of reimbursement that a behavioral health provider will receive. Common examples of behavioral health billing modifiers include:

• Codes for services provided via telemedicine
• The use of multiple providers in the same session
• The provision of crisis intervention services  

Why are they necessary? 

Behavioral health billing modifiers are necessary to indicate the specific type of services provided, such as those that are extended, unique, or exceptional. This information helps the insurance companies determine the reimbursement amount for the services provided and helps in proper claim processing and payment.

By using these modifiers, behavioral healthcare providers can ensure that their claims are accurately processed and receive appropriate payment for their services.

How do you use modifiers to indicate the type of service provided?  

Modifiers indicate the type of service provided by adding a two-digit code to the end of the procedure code for the service. 

• For example, the procedure code for a therapeutic session with a mental health provider is 90837, and the modifier 52 (reduced services) could be added to indicate that the session was shorter than the typical session. Similarly, the modifier GT (via interactive audio and video telecommunications systems) could be added to indicate that the session was provided via telemedicine. 

The exact codes and their usage will depend on the specific guidelines of the payer, such as Medicare or a third-party payer.  

What are some of the most common modifiers used in behavioral health billing? 

Behavioral health medical billing demands accuracy from the documentation that ultimately dictates the codes and modifiers that will generate reimbursement. Common modifiers range from a discontinued procedure to service expectations not being met.  

Some of the most common modifiers used in behavioral health billing include: 

• Modifier 25: significant, separately identifiable evaluation and management service by the same physician or provider on the same day as another service

• Modifier 27:  various evaluation and management encounters conducted on the same day

• Modifier AF: physician delivering SUG group counseling 

• Modifier GT: to identify a service as telehealth 

• Modifier HE: mental health program 

• Modifier HP: doctoral level 

• Modifier HQ: group setting 

It’s important to note that each insurance company may have specific requirements and policies regarding the use of these and other modifiers for behavioral health billing. Behavioral healthcare providers should familiarize themselves with the policies of the insurance companies they work with in order to ensure that claims are processed accurately and that appropriate payment is received for the services provided. 

How can you ensure that your claims are processed correctly when using modifiers for behavioral health services? 

Modifiers used for behavioral health billing are vital components of submitting claims that will result in reimbursement that precisely reflects the services rendered to your patients. 

Following these best practices may reduce claim denials and help to give you the most out of your documentation: 

• Understanding your payers: policies and requirements vary from one insurance company to the next and may update periodically. Stay updated with each payer to ensure you get all the critical information that could affect your facility. 

• Accuracy in coding: applying the correct modifier is essential. Match the modifier to the type of service provided, which gives the payer a clear understanding of the documentation. Clean claims and a reduction in denials are the results of accurate coding.  

• Thorough documentation: always include the diagnosis codes and the treatment plan in your documentation. Proper annotation of codes and plans is fundamental for processing claims accurately.  

• Regulatory updates: Changes in coding and billing regulations may impact the use of modifiers. Staying informed of these changes can help ensure that claims are processed correctly. 

• Consider outsourcing your billing: partnering with a reputable billing and coding company can ease the burden of the overall billing process and give you back the time you need to focus on patient care.  

Coronis Health is more than a billing company. We can partner with your facility to optimize your documentation practices and improve the health of your revenue cycle. 

If you want to learn more about how to get back to what matters most – your patients – schedule a free financial health checkup with Coronis Health. Our team finds missing revenue in 95% of our audits.  

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https://www.coronishealth.com/blog/what-modifiers-are-used-for-behavioral-health-billing/

Anesthesia Medical Billing; 5 Tips to Maximize Profits

Efficient anesthesia medical billing ensures your facility remains financially independent while supporting the high cost of providing patient care. But ensuring you get paid on time for all your services isn’t always straightforward. 

How can you avoid losses and guarantee timely and complete reimbursement for your services? Below are five anesthesia medical billing tips to help you efficiently manage your billing process and maximize revenue:

1. Understand What Anesthesia Billing Codes to Use

Billing codes provide essential information about an anesthesia service. ICD-10 codes establish medical necessity by indicating why a service was performed, helping to determine if the service adheres to the patient’s coverage policy.

ICD-10 and CPT codes regularly change, and medical billers need to stay up to date to avoid inaccuracies and rejected claims.

2. Use an Electronic Health Record (EHR) System

Anesthesia medical billing software, such as using an EHR, increases efficiencies by streamlining workflows and tasks. 

Automation of clinical documentation can result in the following:

• Accurate coding
• Increased accessibility and interoperability
• Reduced medical errors
• Improved patient care (through better management and patient education) 

The organization, efficiency, and patient satisfaction you achieve will increase revenue. 

3. Use the Correct Anesthesia Billing Modifiers

In addition to CPT codes, claims should be submitted with accurate modifiers. Modifiers are two-character indicators that provide additional information related to a service’s procedure code.

When billers use the wrong modifiers, claims are often denied or rejected. Using the correct modifiers ensures consistency and accuracy in filing claims and timely reimbursements.

The Healthcare Common Procedure Coding System (HCPCS) indicates all modifiers specific to anesthesia services which are standard on claims submitted to Medicare and many other payers. 

4. Keep Staff Up-To-Date on Correct Billing Procedures

Your staff must know the ins and outs of medical billing for anesthesia. The first step towards improving efficiency is understanding how the billing procedure works fully. A medical billing system involves the following main steps:

• Checking insurance eligibility 
• Collecting payment from the patient
• Checking and using the correct codes
• Submitting of medical claims
• Completing payment collection
• Resolving issues surrounding denied claims
• Keeping track of denial statistics

By establishing a clear billing system and remaining current on changes and trends, you can ensure a smoother workflow and faster collection process.

5. Outsource Your Anesthesia Medical Billing 

Anesthesia medical billing is no simple matter. The process involves meticulous documentation and a strong understanding of billing codes and regulations to ensure accuracy and compliance.

With all the complexities surrounding anesthesia billing, consider outsourcing your anesthesia medical billing to a company with specialized tools and services to help mitigate compliance risks while maximizing your revenue. When the experts are handling your anesthesia medical billing, you can reduce administrative burden, minimize errors, and avoid denied claims.

At Coronis Health, we bring together the country’s top medical billers and pool our global resources to bring customers tailored solutions for optimized revenue cycle management and anesthesia medical billing services. With decades of experience in the industry, the most advanced technology, and robust intelligence, we can help maximize your revenue while you get back to treating your patients. To learn more, contact Coronis Health to request your free financial check-up.

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https://www.coronishealth.com/blog/anesthesia-medical-billing-5-tips-to-maximize-profits/

Electronic Billing for Behavioral Health; How to Leverage Technology

Technology provides an advantage for behavioral health organizations to streamline processes, engage in best practices, and improve patient outcomes. Developing efficient processes optimizes an organization’s ability to function. Electronic billing for behavioral health incorporates technology to leverage time and skills, reducing the workload for behavioral health teams. Find out how you can leverage technology to benefit your facility.

What Is Electronic Billing for Behavioral Health?

Using paper charts is a thing of the past. Electronic charting is fast and efficient. It also helps to eliminate errors and lost information. 

Electronic billing is another way to promote efficiency and accuracy for healthcare organizations, enabling timely reimbursements. Electronic billing connects with the electronic health record (EHR), allowing data to cross over from documentation with appropriate diagnosis and procedure codes. 

The CMS-1500 or UB-04 are common claim forms for healthcare organizations. Behavioral health claims are typically submitted with the UB-04, but moving beyond the paper is the best option for a facility. 

Electronic billing gathers information from a provider’s documentation to accurately represent the time spent with the patient and the correlating diagnostic and treatment codes. Claims are submitted either through the practice management component of the electronic health record, a separate billing software, or an outsourced billing company.

How Can It Benefit Your Organization? 

Adopting efficiency in healthcare is paramount to its success. It is a best practice and holds many benefits for an organization. Electronic billing for behavioral health is beneficial in many ways:

• Billing Codes – codes, like behavioral health, are in constant flux. Billing codes may change throughout the year, delaying claims processing or denials. If codes are not automatically updated through the billing software, memorizing behavioral health billing codes can be daunting. Coders must also ensure that the software is consistently up to date. 

• Payer Regulations – codes change, but each insurance payer has rules that must be followed for successful claims processing. Behavioral health billing guidelines correlate with payer regulations, demanding a strong focus on compliance to ensure that claims are submitted per the payer’s specifications.  

• Claims Process – behavioral health billing services call for accuracy with every claim but claims processing is still complex even with comprehensive billing software. Your billers must diligently monitor the process from beginning to end to ensure they capture every bit of revenue.  

• Credentialing – electronic billing is a component of healthcare technology that advocates for efficiency. Still, if a behavioral health provider is not credentialing, that efficiency is pointless, and claims submitted to an insurance payer without full credentialing may result in claim denial. Your facility must ensure that providers are fully credentialed with a payer before they accept any patients with that insurance.  

How Technology Can Reduce Claim Denials and Streamline Your Organization 

Technology platforms ensure convenience for behavioral health facilities. Behavioral health billing solutions include new and improved electronic billing software that verifies eligibility and automates prior authorizations. With deep learning and AI-powered management, claims processing and denial management is a breeze.  

Electronic billing technology aims to reduce errors by connecting with regulatory and coding changes, your organization’s specifications, and how each provider delivers care. Technology reduces claim denials, increases efficiency, and reinforces the importance of focusing on patient care. All of this is possible by embracing technology and using behavioral health billing companies to facilitate growth, increase revenue, and develop a new focus on improving patient care.

Coronis Health can guide you on a new journey by using the technology and expertise to give you peace of mind, more efficiency, and a stronger focus on what matters the most – your patients. Call Coronis Health to request your free financial checkup today!

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https://www.coronishealth.com/blog/electronic-billing-for-behavioral-health-how-to-leverage-technology/

Hospital Medical Billing–The Most Important Things to Remember

The hospital medical billing process is challenging and time-consuming. It involves several components and processes; understanding them is necessary to ensure a smooth revenue cycle.

Demystifying Hospital Medical Billing: Essential Terms and Concepts

Hospital medical billing follows basic standards, which set it apart from other types of billing. To clear up the confusion, here are must-know facts about hospital medical billing:

Medical billing comes in two forms: institutional/hospital billing and professional/physician billing.

• Hospital billing refers to the billing of inpatient and outpatient services, services provided by skilled nurses, and the use of laboratory services, medical supplies, and equipment.
• Professional billing refers to the billing of medical services provided by physicians to insured patients. It includes billing suppliers and non-institutional providers for outpatient and inpatient services.

Billing and coding are different processes. The terms billing and coding are often mentioned together, but they are distinct processes and play different roles in filing claims. 

• Medical coding involves identifying billable data from clinical documents and medical records. Coders assign specific codes as per the description of a patient’s condition and treatments received. 
• Medical billing uses those codes to file insurance claims and bill patients to obtain payments for the services of a healthcare provider.

There are three types of medical systems for billing:

• Closed – a system that is not allowed to make transfers and is represented by only one practice (e.g., EMR or Electronic Medical Records) 
• Open – a system that allows transfers between professionals, practices, and other healthcare facilities (e.g., EHR or Electronic Health Records)
• Isolated – a system maintained solely by patients that is not legally accepted. (e.g., PHR or Personal Health Records)

The Importance of Accurate Medical Billing

Medical billing is the livelihood of any healthcare organization. It requires basic knowledge of medicine and a proper understanding of medical terminology, without which billers could submit claims with wrong patient information or inaccurate codes. The resulting under- or over-payments may cause legal issues and financially impact your organization. 

Accurate hospital medical billing and coding ensure the following:

• Accurate reimbursement – with billing experts and quality protocols, you ensure there is no oversight and errors that could result in claim denials and delayed reimbursements.
• Standardized documentation – uniform documentation helps streamline workflows, enables accurate billing, and prevents claim denials.
• Improved patient safety – accurate medical codes help assess patient health, improve the quality of healthcare, and influence public policies.

Maximizing Your Hospital Medical Billing Reimbursements

Here are ways to become more proactive in the medical billing process and optimize your hospital’s revenue:

• Manage claims properly – since resubmitting claims involves wasted resources, claims must be complete and accurate the first time. Accuracy and completion involve inputting the correct information and codes and double-checking them for any possible error.
• Minimize errors – coders describe a patient’s procedures through standardized codes, such as ICD-10-CM, CPT, and HCPCS Level II classification systems. Examples of common errors are missing, incorrect, or mismatched codes, which may lead to upcoding and undercoding, resulting in denied claims.
  • In addition to hiring expert coders, you may use claims scrubber software that verifies that all codes in a medical claim are accurate.
• Handle denied or rejected claims promptly – act quickly and follow a validated process to correct denials. Track claims as they enter and leave the system so denials are corrected and resubmitted to prevent revenue loss.
• Learn ways to improve your system – analyzing rejected claims and denial trends makes it easier to identify where problems occur and find the solutions to fix them, helping to expedite the claim submission process.
  • In addition, you maintain accuracy and efficiency by staying up to date with the changes in coding regulations. Stay on top of these changes by regularly seeking training, which is less costly than repeatedly receiving denied claims.

Tips for Avoiding Claim Denials

Here is a list of the best practices to proactively avoid claim denials:

• Collect complete and accurate patient information – just one blank field or wrong data entry could result in a denial.
  • Examples of important information you should double-check are the patient’s name, date of birth, policy number, and insurance payer.
• Leverage technology – automating tasks streamlines your workflows and speeds up the process of collecting and retrieving information. Invest in practice management (PM) and/or electronic health record (EHR) systems. These tools prevent important data from getting lost in translation, ensuring more efficiency and accuracy.
• Verify referral and authorizations – taking time to learn which services require referrals and prior authorization means mitigating eligibility and pre-certification issues. 
• Stay on top of changes – it is not enough that your software flags billing inaccuracies. Your staff must always be updated on the changing landscape of Medicare standards and other payors. Attend conferences and subscribe to newsletters to remain aware of the latest changes in billing and coding rules and regulations.

• Learn from previous denials – investigating the causes of denials allows you to learn where problems occurred and determine the best solutions to fix and avoid them. 
• Meet deadlines – missing deadlines established by insurers affects claim filing.
• Conduct performance audits – audits uncover weak links in your system and allow you to find the best solutions to improve your workflow and billing process.

How Outsourcing Your Hospital Medical Billing Can Increase Your Bottom Line

Not every organization has the manpower, talent, and IT resources to keep pace with the rapidly changing healthcare landscape. Finding a billing partner may be the best solution to reengineer your revenue cycle management and increase your cash flow.

Here are four ways outsourcing hospital medical billing services increase your revenue:

• Saves time and money – calling patients, relying on paper billing, and training your staff could be costly and a waste of time. Eliminating these tasks lightens your employees’ workload and reduces the need for hiring and training new staff. 
• Streamlines your billing process – your medical partner integrates the most advanced hospital medical billing software into your current office system. Data becomes standardized and accessible from anywhere in your organization, increasing the efficiency of your billing process.
• Reduces overhead costs – cutting down on expenses is a great way to boost your bottom line. With in-house billing, you spend on wages, employee benefits, licensing of software, clearinghouse, printing, and postage fees. By eliminating these costs, you ensure a healthier revenue stream.
• Increases accuracy of your billing procedures – outsourcing your billing means working with experts who specialize in hospital medical billing. They are trained in proper coding techniques and are constantly updated on the changing rules and regulations. Their knowledge and experience lower the risk of errors and denied claims, helping to increase your net collections. 

To learn more about how your organization can benefit from outsourcing medical billing, contact Coronis Health to request your free financial checkup.

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https://www.coronishealth.com/blog/hospital-medical-billing-the-most-important-things-to-remember/

Hospital Medical Billing Explained

With the challenges of hospital medical billing and coding, hospitals face the daily balancing act of serving their community and making ends meet.

By understanding the fundamentals and intricacies of the hospital medical billing process, your organization ensures a smoother revenue cycle that allows you to focus on what you do best: providing quality patient care. 

What is Hospital Medical Billing?

Hospital medical billing involves creating and submitting healthcare claims to insurance companies to receive payment for services rendered by providers. It also includes billing payers for the medical facilities, special medical equipment and supplies, and laboratory services provided.

A medical biller translates a healthcare service into a claim using the appropriate codes and follows the claim to ensure the hospital receives timely reimbursement.

Common Hospital Medical Billing Pitfalls and How to Avoid them

Common mistakes in the hospital medical billing process that leave you vulnerable to claim denials include: 

• Incorrect billing – occurs when a hospital bills a patient for incorrect services or services they never received.
• Duplicate medical billing – occurs when a hospital bills a patient at least twice for the same procedure, exam, or test.
• Unbundling – occurs when groups of procedures frequently grouped together are billed under separate codes.
• Upcoding – occurs when a diagnosis is inflated from a moderate to a more serious condition or when a patient is billed for a service covered by insurance rather than the one administered, which is not covered.
• Undercoding – occurs when a provider fails to capture all services performed or bills for less expensive procedures.

Your steady revenue flow relies heavily on ensuring there aren’t any billing errors that cause damage to your bottom line. Below are two essential steps that save your staff time and increase your profitability:

Ensuring Accurate and Timely Claim Submissions

Accurate billing and coding are only possible with complete medical records, patient charts, and insurance identification, verification, and authorization. Coders only assign the appropriate CPT codes if they have access to complete and accurate records.

Electronic Health Records (EHRs) help hospitals organize paperwork, streamline processes, and reduce errors by standardizing data and automating tasks such as claim processing. Medical billers and coders quickly access information from EHRs to justify financial reimbursement while maintaining an accurate record of medical events.

Claims scrubbing technology is another valuable tool for hospitals. Claims scrubbing reviews a claim’s accuracy and completeness before submitting them to insurers. 

Hospital Medical Billing and Coding Compliance

A hospital compliance program is vital to avoid delayed payments and costly investigations while improving cash flow and patient satisfaction.

Part of your compliance strategy should be performing internal audits. Conduct a compliance audit to identify inefficiencies in your system. Then, third-party auditors can analyze your billing and coding process and identify workflow inefficiencies and areas of opportunity. These audits ensure corrective actions that help your hospital remain compliant.

A robust training and education program is crucial to comply with hospital medical billing and coding regulations consistently. Educate your providers and staff members about billing and coding compliance, including common mistakes that lead to fraudulent claims. Ensure your billers and coders are appropriately trained and know the current hospital medical billing codes and federal policies. They must also be aware of changes to billing and coding standards set forth by the Centers for Medicare & Medicaid Services (CMS) and private payers.

Develop thorough documentation strategies, including the use of technology tools that help automate tasks, ensure the privacy of patients’ information, and enable users to code data appropriately to allow the accurate transfer and documentation of information. 

The Benefits of Outsourcing Your Organization’s Hospital Medical Billing

Hospital medical billing can be challenging and time-consuming for most providers who need access to the skilled staffing required to perform these tasks efficiently. Outsourcing your organization’s medical billing may be the best solution.

Here is a list of the benefits of outsourcing hospital medical billing services.

• Access to a team of experts – outsourcing to certified billers who have the skill and experience in working with healthcare facilities and insurance payers have a deeper understanding of the nuances of the billing process. They efficiently perform their tasks without confusion about medical terminologies, disease conditions, and codes. Their knowledge and experience ensure you capture every last dollar.
• Reduced errors – professional medical billers specialize in billing and focus exclusively on filing claims. Since they give claims due attention, they reduce errors and inconsistencies, leading to fewer denied or rejected claims. 
• Saves money – outsourcing your billing means you don’t have to spend on training, salaries, and benefit costs. Medical billing companies also offer various pricing models, allowing you to select the best option that suits your needs.
• Better turnaround time and increased cash flow – expert billers are proficient in systematically dealing with large volumes of data. With a skilled workforce and advanced technology tools, they file accurate claims and ensure shorter revenue cycles.
• Enhanced billing compliance – medical billing companies ensure regular training for staff so their coding process is up-to-date and meets industry standards. They ensure compliance is integrated into all operations, including internal and external audits.
• Improves patient satisfaction – relieving your staff from the burdensome paperwork associated with billing enables them to create a more patient-friendly environment in your organization. When healthcare providers devote their time to providing quality care, patients remain happy throughout their stay.

With billing expertise, robust business intelligence, and advanced hospital medical billing software, medical billing companies are well equipped to help organizations of all sizes and types, including rural hospitals, get timely reimbursements for their services provided.

To learn more about how you can benefit from outsourcing medical billing, contact Coronis Health to request your free financial checkup.

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https://www.coronishealth.com/blog/hospital-medical-billing-explained/