Medical billing is a complex process of submitting claims to insurance companies to receive reimbursement for services rendered by the physician and healthcare practitioners. Medical Billers and Providers nationwide face difficulties in establishing best medical billing practices that lead to proper and timely reimbursement for services to improve practice revenue cycles.
With 13 years of Medical Billing experience,
WCH Certified Medical Billing Professionals provide insight to the most crucial practices in medical billing. The following tips establish successful medical billing practices that help submit clean claims that lead to higher reimbursement levels:
- It is crucial that appropriate eligibility and benefits are verified before rendering services. Incorrect insurance information and none covered services are the leading cause of denials that can be easily avoided.
- It is important to submit claims on appropriate and updated claim forms, CMS1500 and UB04 forms or the electronic equivalents 837P and 837I. The type of form submitted significantly effects claims processing. A solid understanding of a practice type is required to receive appropriate reimbursement levels and benefit rates by using the appropriate forms to file claims.
- Claim should be accurately filed in accordance with insurance specific medical policies and state and federal billing regulation/ guidelines. A biller should have a concrete understanding of the HIPPA regulation and compliance policies.
- A biller should have a good understanding of all the information that is required to file a claim. It is important to know the provider type, revenue codes, covered ICD-9 codes and up-to date CPT/HCPCS codes in order to appropriately report services rendered.
- Understanding and Utilizing CMS NCCI (National Correct Coding Initiative) Procedure to Procedure edits and Medically Unlikely Edits (MUEs). It is important to identify Bundled CPT codes when services are rendered by same provider on same date of service. Understanding the NCCI helps correctly submit claims with appropriate modifiers to receive appropriate reimbursement.
- Submitting claims in a timely manner is an important step to ensuring claims payment. Timely filling limit of claims submission varies by insurance company, and provider status ( in/out of network) with the insurance. It is important to know the guidelines to avoid timely filling denial.
- Keeping up to date with the industry trends, state and federal legislation, insurance policy, updates and changes helps navigate through the complex process of medical billing and stay informed. It is helpful to sign up to receive bulletins and news letters on a regular basis.
- Putting in place quality assurance measures to ensure accuracy of claims submitted protects the practice and helps avoid future insurance disputes, refunds or audits.
- Successful Medical billing is a direct link to a healthy revenue cycle. In today’s world the difficulties that are imposed on Medical providers and healthcare practitioners by the healthcare industry leave no room for mistake in the Medical billing process.
