Although the pandemic seems to be waning, the financial impacts will be felt for decades. Physicians and medical facilities were one of the hardest hit areas. As these segments begin to recover, medical billing specialists play a crucial role in the revenue cycle. One area in which they can reduce some of the financial losses is in insurance claim denials. Here's an overview of how they can reduce these losses and improve the bottom line.
The Role of Medical Billers in the Healthcare Revenue Cycle
A medical biller is a key player in medical practice. When a doctor sees a patient, they document every aspect of the visit, from history and examination to diagnosis and treatment. A medical coder then assigns codes to key items in that documentation. A medical biller then uses those codes to bill the responsible insurance company (or patient if there is no insurance). They then follow up with the insurance company to ensure those claims are satisfactorily paid.
The Role of Billers in Claim Denials
Often the revenue cycle goes seamlessly, and the medical provider is paid, or the patient is reimbursed. But sometimes the insurance company will deny a claim. This can happen for many reasons. Perhaps the patient's insurance doesn't cover a procedure, or the patient didn't get prior approval. But often, it's simply a mistake in the documentation, coding, billing processes, or missing documentation. Whatever the reason, these denials are expensive, and it's ultimately up to the medical biller to determine the cause and follow up with the patient, physician, and insurance provider to remedy the problem.
Steps to Reduce Claim Denials
Medical billers have a fundamental role in reducing insurance claim denials. It's important for them to monitor and analyze the reasons behind the denials to discover trends and opportunities to reduce them. When they identify the group or entity responsible for the majority of errors (physician, facility, coders, billers, insurance company) it's important to communicate the problem and work with those entities to overcome the problems. More training, increasing staffing, and better technologies may provide a solution, but some providers don't have those options. One workaround is to outsource.
Outsourcing your medical billing to a reputable third-party medical billing company can reduce the strain on staff so they can focus on patient care and the patient's financial experience. These trained professionals specialize in all aspects of medical billing and dealing with insurance companies. Although it might seem like an unneeded expense, in the long run, it can save money by reducing claim denials and speeding up the revenue cycle.