What are the key factors of successful physician medical billing?

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Physician medical billing is a critical aspect in the industrial growth of a healthcare industrial domain. Effective ways should be adopted to propagate healthcare administrative tasks including physician medical billing and coding and Revenue cycle management. 


Following are the key factors that can lead the providers to successful billing services:   



  • Provide Timely reimbursement:


Physician medical billing services have enabled many private practice physicians and healthcare facilities to secure reimbursements without delay. Physician medical billing experts must provide services exactly the way you need it so you can focus on patient care. They must provide such efficient services that can ensure maximum reimbursement.  



  • Electronic Medical Billing:


Physician medical billing service must include submission of claims electronically with EHR software, securing payments through continuous follow-up, as well as account receivable aging audit. Physician medical billing professionals must have competency in practice management so they can help you with error-free and correct physician medical billing and account reconciliation. Physician medical billing vendors also provide patient statement periodically so that you can avoid account receivable backlog.



  • Medical Coding:


It is often observed that physician medical billing staff doesn’t have any proper certification for these tasks and they carry out these tasks without proper qualification and a mere training. They must have a proper certification and qualification to make the execution of physician medical billing procedures notch above the rest. They must closely work with physicians to code documents as well as analyze patient information kept in electronic health record (EHR). physician billing and coding vendors must also securely host EHR and scrub claims to mitigate the risk of delay or even worse, rejection.



  • Verification of Eligibility and Authorization:


Physician medical billing and coding professionals must adopt proactive measures in real-time to verify patient eligibility and warrant for certain health care procedures. This will lessen the chance of claim denials and rejection for underreporting treatment and procedures that are not covered in the insurance plan of the patient.



  • Perform Account Reconciliation:


Once the healthcare insurance companies returns a claim to physician’s office, physician medical billing professionals must review, reconcile, edit, and resubmit the claim to ensure that you get successfully reimbursed with a higher payout. They must provide complete assurance to handle claims contract in your interest under strict confidentiality.



  • Punctual and Accurate Physician Medical Billing:


Physician medical billing professionals should diligently process bills and collect all dues on time from healthcare insurance companies and manage revenue cycle management effectively so they can lessen down adverse effects on the account receivables. 



  • Comply with the Industrial Standard Record Management:


The records and documentation must be prepared and configured by using the latest EHR software and follow standard practices to ensure that revenue loss is minimized in the trail of procedure. It will help the physician billing industry to thrive up and step ahead in the competitive environment.



  • Flexible Pricing Options:


It is the best approach for large scale hospitals or clinical laboratories to outsource their physician medical billing and coding services to offshore physician medical billing companies. Whilst, offshore physician medical billing companies must provide highly flexible pricing options which can be customized as per their client’s requirements, the resources they use, the time required to complete the task, etc.



  • HIPAA Compliant Processes:


It is the foremost duty of every physician medical billing expert to acknowledge the consistent modification in the medical codes  and comply with the international standards of HIPAA to prepare error-free claims and ensure maximum reimbursement. 



  • Professional Management of Aging Claims:


As claims become older, it becomes difficult to monitor the error and require regular follow-up to prevent payments from falling through the cracks. Therefore, physician medical billing and coding professionals must regularly send statements and process secondary claim only after receipt of payment for a primary claim.



  • Low Risk of Rejection:


In the event of claims denial, physician medical billing professionals and companies must strive to investigate the reason and take sufficient measures to initiate claims appeal. THis approach would mitigate your claims denials and the reimbursement would be honored without risk of rejection.



  • Personalized Attention by Billing Experts:


It is all awry to engage medical staff into two parallel conflicting tasks i.e. healthcare services and physician medical billing. Therefore to focus on each task completely, healthcare providers must think of a strategy to explicit these tasks and provide distinct insight into both of their management.


The physician staff must be able to subject matter experts in practice management software, physician billing medical guidelines, claims management, risk analysis, reporting, billing and coding processes, etc. Physicians can acquire support through single window interaction to understand the scope and progress of healthcare billing



  • Secure Data Management:


Patient’s privacy security is the most salient feature of physician billing profession. The physician billing staff must provide overall security features to the patient’s privacy and manage data integrity. They should be able to exchange valuable patient data through secure FTP and prevent unauthorized personnel from accessing or modifying patient’s data



Instead of squeezing, physician medical billing professionals must focus on specific requirements and compile together a customized workflow that will exclusively benefit physicians. Following is the effective procedure to perform physician billing tasks;


  • Code Diagnosis:


AAPC-certified physician medical billing and coding professionals must have their expertise in ICD, CPT, and HCPCS coding systems and have the skills to review and analyze EHR If the physician coding is being done for surgical dictation.


  •  File and Track Claims:


The claims must be passed and monitored promptly.


  • Verify Eligibility:


Eligibility of the patients for insurance must be assessed and it must be tested that they are pre-authorized in real-time as a batch. 


  • Carry Out Credentialing:


They must ensure that the physician services must not provide under-documented information and furnish all necessary documentation requirements and a single channel is used to transmit data instead of following up back and forth.



  • Handle Claims Denial:


The claim denial management must be effective enough to prevent optimum number of such events that can result in this catastrophic situation.



  • Access Account Balance:


The account balance must be monitored regularly and remainders on outsourcing balances to patients.