Medical Biller and Coder

What Are the Best Practices to Follow for a Medical Biller and Coder?

In the healthcare industry, the medical billing and coding process ensures that healthcare providers are paid for the services they provide. While a strong and efficient setup will keep your practice financially healthy and allow you to focus on your core goals, an inefficient setup can result in revenue losses and even force you to close your practice. 

To reduce the financial and compliance risks associated with poor billing and coding practices, you must take a more proactive approach to your billing procedures and look for ways to enhance the process. 

You need to adopt practices that can ensure that your medical claims are processed correctly and that healthcare providers are properly reimbursed for their services. However, not everyone is equipped with the knowledge of how to improve their billing and coding procedure. 

Hence, in this post, I have shared some key medical billing and coding to get you started on that won’t take long to improve claims management and maximize reimbursements.

Make billing easier for patients

Although medical practices and hospitals are aware of the complexities of the medical billing process, patients are likely to be perplexed. Keeping your patients educated and informed is an additional challenge. 

Your patients’ inability to clearly understand the process reduces their likelihood of making the payment. This is why it is critical to take an approach that requires providers to have a more patient-friendly and accessible process. 

Submit claims timely and accurately 

Making sure your medical billing is correct the first time you submit it can save you time and effort in editing and resubmitting incorrect claims. Similarly, timely submission of claims to your provider is required to avoid any potential delays. 

To avoid billing issues, double-check all claims before submitting them and communicate with the provider if any information is inconsistent, incomplete, or unclear.  Filling out claims correctly and avoiding common errors, such as incorrect patient or insurance information and duplicate claims, can help your medical practice have an efficient medical billing process.

Ensure efficient revenue cycle management 

Revenue cycle management (RCM) is the financial process used by healthcare facilities to track patient care episodes from registration and appointment scheduling to the final payment of a balance using medical billing software.

An effective RCM process ensures that the entire interaction with a patient is effectively managed, from initial inquiry to final payment. Failure to optimally prioritize RCM and revenue collection efforts, regardless of the size of your practice, hospital, or health system, can halt growth, increase operational risk, and create an uncertain financial future.

Focus on improving the process

Because the healthcare industry is constantly changing, you must look for ways to improve your billing practices. Under these conditions, a culture of flexibility and continuous improvement can benefit your practice and help you improve the billing and coding process. 

For example, you must be aware of any changes that may affect billing and coding protocols and, if necessary, seek training. In the long run, this would be less expensive than repeatedly submitting claims. 

You can also track late payments, frequently declined payments, or frequent changes in contact information to better target patients for additional reminders and prepare billing personnel for collections.

Keep track of billing rules and regulations 

Staying informed about changes in healthcare regulations and policies is one of the most important best practices for medical billers and coders. Failure to stay current on medical billing rules can have a direct impact on the cash flow of your medical practice.

Previously, coders relied on manual coding directories to find the right codes, but most now generate electronic codes using digital encoders and digital coding libraries. This is why it is critical to stay informed to create a streamlined process that avoids rejections and medical billing edits.

Reduce coding errors

To keep accurate medical records, a medical coder translates details from a patient’s medical documents, such as physician’s notes, lab reports, procedures, and diagnoses, into universal medical codes. 

While these codes provide a consistent way of describing procedures, mistakes such as incorrect, mismatched, or missing codes can still occur. As a result, documentation must be carefully reviewed to ensure that the codes accurately reflect the services provided.

You must also ensure that you review coding resources and guidelines regularly and stay up to date on coding updates.

Be quick to handle rejected and denied claims

A rejected claim has not yet been processed due to an error, whereas a denied claim has been processed and deemed unplayable due to a discovered violation. 

Your medical billing expert should follow up on all rejected and denied claims and make every effort to resolve them as soon as possible. While a rejected claim can be corrected and resubmitted, a denied claim must first be appealed. 

Look for outsourcing experts 

Medical billing is frequently a demanding and time-consuming task that, unless you have the necessary experience, expertise, and resources to handle it in-house, is best left to professional service providers. 

This is why physicians and office managers prefer to delegate their medical billing responsibilities to a medical billing company. Outsourcing your billing needs allows medical providers to focus more on patient care while also improving cash flow and lowering billing errors. 

Rely on technology and automation 

Medical billers and coders can benefit from technology by streamlining work processes and improving accuracy. For example, you can automate the billing process to reduce errors and expedite reimbursements. 

To ensure that the patient record is complete and accurate, use an integrated EHR and EPM system to match the patient data against multiple data sources. This will give your staff more confidence in avoiding coding errors, typos, and outdated contact information.