5 Tips To Ensure Medical Billing Compliance
Successful healthcare revenue cycle management depends on accurate coding, diligent A/R management, timely claim submission, and argus-eyed process analysis. These are all individual processes, each of which requires specific expertise. But there is another factor that ties all these processes together: compliance. It is not a process. Rather, it is a complete strategy to ensure that your medical billing remains error-free. This also implies that most errors in the medical billing process are a manifestation of noncompliance.
It is worth mentioning here that medical billing noncompliance falls into the general category of fraud. It includes small errors to major discrepancies. And its financial implication can be in the form of extra spending of 3% to 10% of the entire practice budget.
But it is not just the cost you should be concerned about. Noncompliance can affect your reputation and patient satisfaction as well. And in some cases, it may cause legal problems.
In this blog, we will discuss important steps to ensure medical billing compliance. Working on these steps will help you stay in line with regulatory bodies and boost your revenue.
Major Healthcare Billing Regulations
Most people think of medical billing regulations as some guidelines by HIPAA. But the fact of the matter is HIPAA guidelines are just a small part of a large rulebook. Healthcare billing regulations consist of federal and state laws and industry standards. These also include policies from insurance companies.
Below are the major legal standards that regulate medical billing:
- False Claims Act (FCA): This act counters fraudulent claim submission, which can be in the form of omissions or false statements. The liable individual may need to pay an amount equivalent to three times the cost of damages and an inflation-adjusted penalty.
- No Surprise Act (NSA): This standard protects patients from unexpected medical bills. It outlines specific billing and coding rules like out-of-network patient care and emergency treatment. Its goal is to ensure that patients do not get charged for services they didn’t receive.
- Anti-Kickback Statute (AKS): This rule prohibits paying, soliciting, or receiving money for patient services that are part of federal healthcare programs.
Subtle Factors That Threaten Medical Billing Compliance
Your medical billing practice may be clear of any fraudulent activity. But certain errors and factors can increase the risk of violations. Unfortunately, these errors are more common than you think. These include:
- Errors in billing and coding
- Performing unnecessary procedures
- Not updating privacy and enforcement policies
- Weaker defense against cyberattacks
Countering these factors requires a diligent and watchful approach. Below are the steps to develop and maintain that approach.
Impact of Compliance Audits
A national survey of healthcare providers, 2022.
This pie chart showcases the impact of compliance audits on healthcare practices. 72% reported improved billing accuracy, and 28% cited increased revenue from compliance audits.
Important Steps To Keep Your Medical Billing Process Compliant
1. Develop a Comprehensive Compliance Program
This step mainly involves creating a basic compliance framework. It will require you to have a compliance officer on board. They will help you develop and write down all the policies with all their nuances.
The key aspects of a compliance program include the following:
- Training your employees to ensure regulatory compliance
- Developing systems that help ensure documentation accuracy
- Developing an analytics system for complete reporting
- Inspecting all the departments for violations
- Having a system in place to timely address any violation
- Evaluating the risk of future non-compliances
2. Use Technology To Your Advantage
Compliance requirements have become tough. But you can still ensure complete adherence through automated tools and applications. Many healthcare IT organizations have developed smart systems that assist in practice management. These systems look into the running operations and identify discrepancies that can lead to violations. Some systems even detect patterns that can result in discrepancies.
However, it is important to choose your software solution wisely. The first thing you want to look into is the features. Make sure that your prospective system has all the features your practice needs. Secondly, be sure to choose a software solution from a certified vendor only.
3. Review Payer Policies Carefully
Payer policies can be too intricate to understand. Ending up not fulfilling any of those can lead to denials. Therefore, it is always in your best interest to read the payer contract carefully and ensure you understand everything. Pay specific attention to clauses like:
- Fee schedules
- Dispute resolution
- Network requirements
- Medical necessity
4. Run Billing And Coding Audits On A Regular Basis
No matter how well you go with the process, compliance errors can still occur. The best way to deal with them is to have a strong system in place. Your software solutions can help here. But you will ultimately need a team of humans to do the real smart work.
Therefore, ask your audit team to regularly look into claim processing, financial records, and documentation. Instruct them to not just fix errors but use that data to prevent future discrepancies. If possible, outsource your medical billing audit to a third-party company.
5. Respond To Denied Claims Quickly
This step is very important to keep the cash flow streamlined. The chances of a denied claim getting approved are high if you respond quickly. The more time you spend rectifying, the more things will get out of your hands.
Conclusion
Medical billing compliance is a necessary strategy to maintain healthy operations. It is a tough requirement for sure. But it brings your practice into an optimal position. The above steps can help you stay compliant and ensure that your operations run flawlessly.
At AltuMED, we offer expert services to help you stay compliant. Our billing team is top-rated in the industry. Our revenue officers have the utmost financial skill and knowledge. And our audit team leaves no stone unturned when assessing your practice. For details, contact us today.
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