Hospitals, medical practices, and other provider organizations throughout Florida need to be aware of the increased risk medical billing poses to their revenue cycle. Recent reports indicate medical billing will be one of the leading causes of revenue disruption in 2019. If these entities don’t take preparatory action now, they run the risk of losing significant funds as well as damaging their reputation.
Identifying issues with medical billing early on is key to avoiding costly mistakes down the road. To do so, providers should pay close attention to the following:
- Billing accuracy. It is vital that providers only bill patients for services rendered. Upcoding or unbundling are fraudulent practices and can land providers in hot water. Duplicate billing, even if accidental, can have financial consequences as well so providers need to take pains to ensure their billing practices are above reproach. This improves patients’ trust as well as the practice’s reputation.
- Lost revenue. The most common source of lost revenue is claims denial. If a claim doesn’t go through, the provider doesn’t receive payment for it. Providers need to make sure they work all denied claims to receive the maximum reimbursement due to them.
- Poor denials management. Expanding on the above point, providers need to investigate the cause of denied claims. A claims denial rate of 15% or less is common, but it’s worth investigating to make sure a simple mistake isn’t the culprit behind the denials.
- Lack of transparency regarding third-party billing process. Many providers outsource their medical billing. However, some medical billers are better than others are and it’s worth it to do some research before selecting one. Providers should opt for medical billers that are transparent about how they process claims. Otherwise, they run the risk of making inappropriate charges and confusing patients about their bill.
- Supporting documentation. Medical providers need to ensure they submit documentation on official medical forms or letterheads when processing claims. This provides proof for services rendered and can boost patient trust in their provider. Providers need to take pains to ensure they only bill patients for services rendered. The more accurate and transparent this process, the better.
There are several risks associated with medical billing, most of which are within medical providers’ control. However, providers can’t predict every risk. If you’re concerned about your medical practice’s risks, the experts at MMA Florida can help. Contact us to learn how we can help.