Three Signs You Need Coding Help
One of the most critical components of operating a successful medical practice is correct medical coding. Improper coding can result in the loss of revenue and have legal and financial consequences for a medical practice.
Mednet focuses on assuring that our clients bill for and get paid for every dollar they are entitled. We stay focused on the financial aspects of proper coding so you can focus on your patients.
But how do you know when your practice needs help coding? Here are three signs:
Reimbursements are Less than They Should Be
As a doctor, you know how many patients you see each day and the services you provide. While you may not be able to guess the exact amount of revenue you’re bringing in, you have a general idea.
Common coding errors, like missing information or incorrect procedure codes, may result in a lack of payment to your practice. You may also be failing to recognize a billing opportunity, which can also affect the revenue you earn.
Have ever reviewed your monthly or quarterly numbers and thought, “Wow, I thought the revenue for this last period would be higher?” You may want to trust your gut and review your coding procedures to ensure that you are collecting the correct amount on every service you provide.
Payments Are Delayed, Reduced, or Do Not Occur
This next sign is often the main culprit of loss of revenue. When you submit claims with incorrect coding, payment for those services is most likely going to be delayed or reduced, if they happen at all.
Insurance companies wil not pay for services that are not covered in their contract. And it is always difficult to collect from patients who thought their insurance covered a service provided by your practice.
This is why proper coding is so necessary to your revenue cycle. You want to correctly document services rendered for the patient so that insurance companies reimburse you in full for everything that you do.
Productivity of Entire Practice is Lessened
This last sign may very well be the most insidious because it is the hardest one to recognize. If insurance companies are denying claims because of improper coding, then you will have to have someone on your staff rework that claim. But there is an opportunity cost to this. For every claim you have to revise, there is a task that may be delayed or not done at all.
A lot goes into operating a successful practice. If you spend too much time redoing work that should have been done the first time correctly, you are losing out on ways to improve how your practice operates.
These are no easy metric to recognize or quantify, so it may be weeks or even months before you understand why your practice is not operating as smoothly as it should. This is another “trust your gut” situation. If there are projects or tasks not being completed, or if you recognize one or both of the first two signs, then chances the overall productivity and revenue of your practice is suffering.
Incoming revenue is the lifeblood of your practice. You need it to pay your staff, for the office, for supplies, and everything else that goes into operating your practice. To keep the revenue flowing at the maximum level, you need to ensure your coding is correct.
If you see any of the signs listed above, then you must investigate, or you can risk the long-term success of your practice.
How to Find Success in 2020
A new year, and a new decade, is upon us. This time of year presents an excellent opportunity for reflection and looking back at our successes so we can take a moment to appreciate them. It’s also a time to take a look at our shortcomings, so we can learn and grow from them.
And we can use these lessons from the past and apply them to the new year to see how we find success. We want to assist you in this by looking at which billing and operational trends you can look forward to so you can plan for a more successful 2020.
Medical Billing and Coding Trends
If the physicians and the staff are the engines that keep your practice going, then it is safe to say that the billing and coding is the fuel. After all, if you don’t get paid for your services, your practice won’t be around for too long. The following trends utilize technology with one goal in mind: make the process of getting paid more accessible and more efficient.
- Cloud-Based Medical Billing Software - The “cloud” has become a popular mechanism for many industries. For medicine, it remains a bit controversial due to concerns with security. It is safe to assume that companies are taking significant measures to make the cloud a more secure option for medical billing. As this happens, you can count on the cloud becoming a more attractive option for practices needing to access their patient info on the go.
- Electronic Claims Processing - This is not a new trend as the software for processing claims electronically has been around for quite some time. However, in the coming year and beyond, the software developers will improve the capability of their programs. This will open the door for automated billing options that are more useful and easier to operate.
- Computer-Assisted Coding - Designed to make the coding process more efficient, Computer-assisted coding, or CAC, helps determine which codes might be needed and highlight any errors. As with any new technological development, when first introduced, there was skepticism around CAC. Like other technological developments, it is more widely used now that the technology has improved (and will continue to do so).
The big takeaway for billing trends is to keep an eye out for how technology is impacting the process of submitting claims and getting paid. Chances are there is something in development that can help address a problem you are experiencing. As always, you can contact us with any questions you may have.
Many things can impact how well your practice runs on a day-to-day basis. Let’s look at a couple of trends that might help your practice run a little smoother:
- Outsourcing RCM Services - In 2019, a record number of practices outsourced their revenue cycle management (RCM) services. The trends mentioned above take time and effort to learn and monitor. And if you choose to implement a change, that is time, money, and effort that you have to invest in making the change. It may be more cost-effective to outsource your RCM services so you can focus on taking care of your patients and managing your staff.
- EHR Integration/Interoperability - The global digital health market is forecasted to surpass $379 billion by 2024. Integrating electronic health records (EHRs) with other technologies practices daily has helped propel this trend forward. One of the most significant inefficiencies many practices face is having an EHR that is not integrated or does not operate with another essential program or service they use. In 2020 and beyond, addressing this inefficiency will be a priority.
As with billing, keeping an eye out for what may help you manage your practice more effectively and efficiently will be essential. Start with writing down where you believe the most significant problems or inefficiencies rest and research how you can address them. If you need any help, you know who to call.
Bonus: Patient Experience
We would be remiss if we did not take a moment to highlight what may be the essential part of your practice: your patients. They are truly what keeps your practice going, and like any other business, you have to keep your customers happy. So whether it is setting up virtual visits or making a bill easier to pay, make sure to take the time to make your office experience as pleasant as it can be.
How to Prevent Claims from Being Denied
Last month, we shared the five ways Mednet makes you more money. Although the list was in no particular order, the first item was submitting accurate claims. As this infographic illustrates, the average cost to file a claim is $6.50. The infographic also details that the cost to resubmit a claim ranges anywhere from $25-$118. The total cost to submit, correct, and resubmit a claim can range anywhere from $31.50 to $124.50 — costing your practice thousands of dollars per year.
Here are some other troubling numbers from a report on beckershospitalreview.com:
- According to recent estimates, gross charges denied by payers has grown to an alarming 15 to 20% of all claims submitted
- As many as 65% of claims denials are never worked, resulting in an estimated 3 percent loss of net revenue
- Roughly 67% of all denials are appealable
We are not sure about you, but losing 3% net revenue does NOT sound like the best way to run a business.
Mednet gets paid on over 98% of all the claims we submit, so we firmly believe we are experts in preventing claim denials. Here are some of our top tips to help you prevent your claims from being denied:
Do Your Homework: Part I
The only real constant in the medical industry is the change. Your staff must be on top of any and all changes in rules and regulations. By fostering an environment of constant learning and improvement, everyone on your team will understand the importance of staying up-to-date, eliminating denials due to failure to keep current.
Do Your Homework: Part II
Look internally and investigate the cause of past denials. Understand where mistakes may have occurred and how you can avoid them in the future. If necessary, implement corrective actions to curb future denials.
Work As A Team
Denied claims affect the entire practice. Everyone on your staff should understand this. Even if they do not work directly with billing, each staff member should do their part to ensure the billing process is a smooth one. Help your team communicate what is needed, and, when a mistake happens, do not rush to place blame. Take time to search out the cause and help them understand how to prevent it from happening in the future.
Make Sure Pre-Authorizations Are Done Correctly
Pre-authorizations can help lower the number of claims denied, but only if they are for the scheduled procedure. Carefully document what was authorized and do checks before the procedure. If anything changes, document what was changed and double-check everything before submitting the claim.
This is a broad category that encompasses the above points, but also includes:
- Incorporate automation: Many software providers have tools that will help automatically update codes and procedures. Tools like this, as well as other project management tools, streamline the billing and claims process.
- Review your work: This seems like a simple step, but for one reason or another, it is often overlooked. Working as a team can help with this step because it is easier to spot someone else’s error than to catch your own.
- Meet deadlines: Meeting deadlines is essential. There is no excuse for having a claim denied because you missed a deadline. Again, working as a team can prevent a missed deadline.
In the end, you can help prevent claim denials by setting up a process for your team to follow. Set up a system that you can repeat for each claim that also allows for periodic review so you can determine where you need improvement.
It may seem daunting, but can you truly afford not to follow a process? It can cost you as much as 3% of your net revenue.
If it’s still too overwhelming, remember that Mednet is here to help with your medical billing needs. It might be a worry we can take off of your plate so you can focus on more important things, like your patients.
Five Ways Mednet Makes You More Money
Running a medical practice is difficult. No matter your specialty, you most likely face many challenges: compliance, administrative requirements, staffing issues, managing your revenue cycle, and cash flow. That is a lot to deal with, and we did not even mention ensuring your patients are happy and healthy.
Given all that goes into properly operating a medical practice, it’s important to know that help is out there and, even more importantly, how that help can propel your practice towards growth.
That’s where Mednet comes in. And there is one challenge we are exceptionally good at: ensuring your practice makes more money.
Let’s take a look at exactly how we do this:
Accurate Claims Billing
It all starts with submitting accurate claims. Because claims is how your practice gets paid for the services you provide for your patients, if the claims you submit are not accurate, they can be rejected or denied. And the process to clarify any errors can be costly in terms of both time and money.
Mednet gets paid on over 98% of all claims submitted. When we submit a claim for you, you’ll know that it is accurate. You will not have to worry about wasting time and money fixing inaccurate claims and delayed payments.
Improve Coding for Higher Reimbursement
A major part of submitting accurate claims is proper coding. Knowing which codes and modifiers to submit for which services you provide ensures that your practice does not lose any revenue. But it can also be a very complicated process, and one you need special knowledge to do correctly.
Mednet’s team of certified coders are trained in coding and chart audits. No matter your billing coding needs, we can meet them.
Aggressive A/R Management
No matter how experienced or good you are, claims do get rejected or denied. As stated above, resolving these issues can be costly. And if you fail to resolve the issues, you are leaving money on the table.
Mednet is aggressive in A/R management and and follow best practice standards. If a claim is rejected or denied, we quickly and efficiently follow up on your behalf to ensure there is no lost revenue.
Dedicated Account Managers
When you work with Mednet, we assign a dedicated account manager who handles all aspects of your medical billing needs.
Over time, your account manager comes to know your business and will feel like part of your staff. This strong relationship is important when it comes to handling the day-to-day challenges of medical billing.
Extensive Knowledge of the Industry
Mednet has been in business for over 30 years. Our Management Team has over 100 combined years of experience working in the medical billing field. We know the “ins and outs” of revenue cycle management, and you will feel confident that you are working with trained, experienced, and educated professionals who know how this industry operates.
You have a lot to worry about when it comes to operating your practice. Why not take something off your plate, a worry off your shoulders? Mednet gives you peace of mind because you know that the billing and coding is being taken care of.
Don’t waste any more of your precious time or money. Contact Mednet today to see how we can help revolutionize your medical practice.