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Denial Management, Patient Collections

In the medical billing industry, certain issues are a persistent problem. Often, department managers and billing staff will simply react to problems instead of proactively predicting future issues that may occur. With the challenges of managing the day-to-day operations of a modern healthcare practice, it is easy to only deal with immediate problems. However, if a medical office or billing department main focus is on putting out fires, they may not look for what is actually creating these fires in the first place. There is a danger in viewing the separate pieces that make up a coherent and efficient revenue cycle management system. From denial management to patient collections, the entire process needs to work as a streamlined system.

With this in mind, here are 3 problems that consistently plague medical billing departments:

[1] Improving Patient Collections:

Educating patients about the details of their specific insurance plan is a crucial step in the modern healthcare RCM. Due to recent changes, patients are sometimes confused about what their insurance actually covers. With the growth of high-deductible plans and limited in-network options, patients need to understand what medical treatments are considered their financial responsibility. Healthcare providers can alleviate this situation by clearing informing patients about their insurance coverage. If this educational process is done properly, patients will have a better customer experience and fully understand the details of their statement. Educating, as well as providing, patients with easy payment options streamlined billing statements will also improve a medical group’s overall relationship with their patients.

[2] Aggressive Denial Management:

Denied claims are a problem for many billing departments. The goal of a sound denial management policy is to reduce denial rates to as low as possible. A percentage in the single digits is the goal, but for many medical billing departments, this is a hard KPI to achieve. The quickest and most direct way to combat denials is have established clear and open lines of communication with all of the key stakeholders. Offices need to have a system that organizes workflow in a matter that helps to prevent denials and manage them when they occur. Specific multidisciplinary task forces can train billing staff to minimize or avoid errors, which will quickly decrease denied claims. Open lines of communication and a logical workflow will make sure that “clean” claims are promptly produced, processed and paid by the insurance provider.

[3] Office Staff Quality:

A medical billing department lives and dies by its staff. Locating and motivating medical billers and coders is a serious task for many healthcare practices. The task of training and maintaining a top-performing RCM team should not be taken lightly. Great customer service is just as important as understanding the details of healthcare billing and coding. This means that a good phone etiquette is just as important as the ability to obtain a pre-authorize or understand CPT and HCPCS codes. In order to do this, medical office staff need clear and consistent training. Performance is monitored but creativity is encouraged in order to remedy new or ongoing problems. The goal is to develop a sense of synergy where the overall group is more productive and valuable than the many separate individuals who make up the group.

At ABCS RCM, we offer experienced medical billing services. For additional information about medical billing problems or other general questions:  CONTACT US

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Denial Management, Patient Collections

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