Understanding and Improving the Medical Billing Cycle

  • Written by Yash Rajan
  • Monday 5th September 2022
Understanding and Improving the Medical Billing Cycle VLMS Healthcare

Accounts receivable reflect the state of your revenue cycle management and highlight the possible issues related to it. Hence, when it comes to improving your accounts receivable, the first suggestion offered is to always improve the revenue cycle management of the organization. Accounts receivable ensure the recovery of pending reimbursements by addressing the pending claims, appealing the denied claims, and following up with the patients for pending payments. Accounts receivable represents the amount which a healthcare provider is liable to receive for the services they rendered, from a patient or their insurance company. Any healthcare provider always expects that the days for A/R would be fewer and they will get paid as soon as possible. As the payments get delayed, the likelihood of getting reimbursed for your services decreases. It is a major cause of revenue loss in the healthcare industry. A/R management carries its significance because it is linked with revenue leakage. Revenue leakage can have a serious impact on the practice of your organization. Revenue is necessary for running the organization, but due to a lack of sustainable revenue, many healthcare organizations close their service. This is generally the case in areas where patients are scarce. Hence, understanding how you can improve your A/R management and reduce the days in A/R can significantly boost your revenue cycle.

Improving the patient interaction
The medical billing cycle represents the process of generating revenue in healthcare organizations. It represents the entire process from collecting the patient information while setting up their appointment to filing an insurance claim and getting reimbursed for the services rendered to them. A/R management handles the reimbursement part of the medical billing, which is the final part.
If you have a perfectly managed medical billing procedure, you are going to have a perfect hold of your A/R. This is because, even a small mistake of getting the patient information wrong while scheduling an appointment, can result in a denied claim and thus increase the days in A/R. Therefore, the first step in improving the A/R management is to eliminate the flaws in your medical billing cycle.

Claim filing
Claim filing requires the maximum attention, as a small mistake can cause you the revenue you are liable to receive for your services. Hence, the process of claim filing needs to be performed with maximum attention. From collecting patient information to making a charge entry based on a charged sheet and using the medical codes for the insurance claim, one has to make sure it's error-free.
The charge entry should be done accurately as per the charge sheet of your health organization. Based on the services mentioned in charge entry, the medical coder then uses the medical codes for filing an insurance claim. If everything is accurate and well documented, the provider receives reimbursements for their service.
Regular audits of the medical billing cycle are the key to addressing the possible issues. Monthly audits are more likely to highlight these possible issues and timely fixes for them.

Timely follow-ups from patients
Patients now prefer more for self-pay to relying on their insurance. The trend of self-pay has increased the responsibilities of healthcare providers. This is because, earlier when they have to interact with one insurance company for several patients. Now they have to interact with the individual patients for the same. This is already stressing out the healthcare providers who are already busy addressing the growing health burden of the country.

During patient interaction, the physician should consult the patient and help them understand their payment liabilities. Then the key is to regularly follow up on the patient for the pending payments. Follow-ups are also necessary when dealing with the insurance company. It helps you to understand the status of pending claims, the reasons behind denied claims, and timely filing an appeal against them.

The process of getting reimbursed for your services is tedious and sometimes frustrating. We at VLMS Global Healthcare handle your complete medical billing cycle, revenue management, and your A/R, allowing you to shift your focus on providing excellent medical services to the patients. Hence, if you want to focus on your practice and are considering outsourcing your medical billing cycle, consider reaching out to us.

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