best-practices-for-optimizing-medical-billing-and revenue-cycle-management

Best Practices for Optimizing Medical Billing and Revenue Cycles

Streamlined medical billing is key to healthcare practice viability. Medical billing complexity rises with diverse workflows, payer demands, tech advances, & industry changes.

Article details essential clinic actions for optimal reimbursements & success in evolving healthcare landscapes.

Complete, Accurate Patient Data for Optimized Reimbursement

Accurate patient data capture is vital for maximizing reimbursements through precise medical billing. LinkedIn emphasizes fast insurance checks, digital registrations, & seamless platform integration for revenue success.

1. Insurance Eligibility Verification

  • Automated Eligibility Checks: Real-time API checks authorize visits and catches coverage changes, preventing claim rejection.
  • Batch Eligibility: Batch eligibility checks for scheduled visits streamline staff work and confirm active coverage.
  • Multi-Payer Eligibility Databases Allow single-source validation against benefit details across major insurance providers, saving duplicate entries.

2. Streamlined Patient Demographic Capture

  • Online Portals and Mobile Apps: Portals & apps let patients update cards, schedule visits, & make payments, reducing data errors.
  • Digitization Workflows: Digitized workflows like scanned cards, e-signatures, & tokenized payments improve accuracy over manual input.
  • Email/Text Reminders: Requesting updated details spurs patient confirmation of information truthfulness.

3. Tight Platform Integration

  • Shared Master Patient Index: Syncing demographics, guarantor info, and insurance policies across systems prevent fragmentation.
  • Auto Data Sync: It eliminates re-entries, improves accuracy, and reduces denied claims from mismatched records.
  • Unified Reporting and Analytics: Combining clinical and financial data allows for informed decisions on maximizing revenue.

Synchronized patient data across systems prevents denied claims and cash flow issues. Smooth data flow across EHR, practice management, and billing drives accuracy.

Prevent Claim Denials Through Ongoing Coder Education

Training, audits, and smart tools cut coding claim denials amid changing guidelines.

1. Continuous Training Tuned to Specialization Nuances

  • Role-specific Education: It offers tailored periodic workshops for physicians, nurses, coders, & billers aligned to responsibilities.
  • Specialization-focused Training: It provides emergency department or surgery-specific seminars preventing niche errors.
  • Payer-led Seminars: Outline denial reasons, new policies, and documentation specifics to help coders adjust workflows.
  • Self-paced Training Modules: It encourages skill development across changing regulations.

2. Auditors Identify Documentation and Coding Gaps

  • Concurrent Reviews: The sampled cases provide real-time improvement opportunities without repayment risk exposure.
  • Code Combination Audits: It investigates the frequency of error-prone coding pairs to prevent repeated issues.
  • Specialized Auditing Expertise: It is from remote consultants tuned to specialty-specific requirements.

3. Automation-Assisted Coding Software

  • We embedded a Coding Rules Engine: To check appropriate code combinations, avoid bundling, unbundling, upcoding, etc.
  • AI-based CAC Solutions: It suggests codes from physician notes, increasing coder speed and accuracy.
  • Robotic Process Automation: It streamlines administrative coding tasks, reducing mundane human errors.

Continuous education and expert audits are vital for efficiently mastering complex medical coding.

Consolidated Practice Solutions Eliminate Data Disjoints for Revenue Maximization

Integrating EHR, RCM, analytics, and patient engagement improves efficiency and accuracy. Integrated systems reduce duplicate data and align records across workflows.

1. Shared Master Patient Index Across Platform Modules

  • Centralized patient data synchronizes identity across clinical and administrative workflows.
  • Preventing data loss between systems reduces denied claims.
  • Staff can access patient financial data and clinical history with one search.

2. Integrated EHR-Billing-Analytics for End-to-End Automation

  • Auto-sync between EHR and practice management boosts accuracy by eliminating manual errors.
  • Coded encounters flow from clinician notes to billing, triggering automated payer submissions.
  • Payments post seamlessly to patient accounts without manual application across disconnected systems.
  • Integrated analytics provide real-time revenue insights by specialty, provider, procedure, etc.

3. Interoperability Bridges External System Data

  • Even with an integrated platform, healthcare workflows involve external systems like labs & pharmacies.
  • Interoperability APIs continually pull data from third-party systems preventing data silos.
  • Patient portals and apps integrate data to provide comprehensive views across engagement.

Unified data digitizes patient workflows, covering financial transactions, consumer exchanges, and payer interactions.


Revenue Cycle Analytics: Preventing Claim Denials and Bottlenecks

Detailed revenue cycle tracking with actionable analytics streamlines workflows and maximizes reimbursements. Key data strategies include:

1. Denial and Revenue Leakage Insights Across Dimensions

Dashboards track denials, rejections, coding issues, and revenue leaks for targeted improvements.

  • Metrics by department, physician, coder, & claim type identify problem areas for targeted solutions.
  • Code combination auditing highlights the highest error-prone pairs needing added edits.
  • Longitudinal views assess if coder education or EHR upgrades reduced average denial rates.

2. AI to Determine Denial Root Causes and Patterns

  • Natural Language Processing Parser Denial Reason Texts to categorize major descriptions of rejection
  • Denial analysis identifies trends by period, coder, claim type, etc. for evaluation.
  • Insights drive focused audits and training priorities, supported by automation-assisted intelligence.

3. Configurable Real-Time Claim Scrubbing

  • Automated claim scrubbing catches errors like invalid code combinations before submission.
  • Logical configuration aligns checks to evolving payer policy documents accessed via cloud-based databases.
  • Continual feedback refines scrubber rules, improving accuracy based on actual rejection reasons.

4. Model Claim Payment KPIs to Set Data-backed Goals

  • Analyze historical claims to model how denial rate reduction impacts payment cycles.
  • KPIs use clean claims ratios, rework rates, etc., to set data-driven cycle time and revenue goals.
  • Analytics-based forecasts help leadership assess returns on procedural or technology investments.

Revenue analytics streamline processes and convert data into revenue by identifying bottlenecks.

Next Step: Assess the Maturity of Your Medical Billing Capabilities

Healthcare digital transformation has potential, but managing change during technology implementation is challenging.

Clinics need expert guidance to assess bottlenecks, design future processes, & select tailored solutions.

We offer specialized help for optimized medical billing and revenue cycle management.

Is inefficient medical billing dragging down your practice's financial health?

Our end-to-end revenue cycle solutions maximize reimbursements through accurate coding, real-time claim scrubbing, integrated platforms, and data-driven analytics. Let our experts at AltuMED optimize your workflows for reduced denials, faster payments, and revenue growth!

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