Looking Back at Our Top Medical Billing Revenue Cycle Tips

April 20, 2023

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RCM Tip of the Month: A Recap

11 ways to help improve your practice’s claims submission and medical billing processes.

This month we’re going to walk you through our top medical billing revenue cycle management (RCM) tips, from the past 11 months. Each tip is focused on identifying the right metrics and developing a more strategic approach to your practice management and business operations.

Here are our top tips from the ever-evolving world of RCM:

#1. Office Visits Are Opportunities for Patient Collections

An office visit is an opportunity to collect any outstanding balances from patients or make payment arrangements.

#2. Review Patient Claims Before Submitting

Did you know that U.S. doctors lose an estimated $125 billion in revenue each year to poor billing practices? And Up to 80% of medical bills contain errors that often lead to denied claims. What’s to blame for holding up most claims? Incorrect patient or provider information, invalid or missing codes, duplicate billing, and lack of documentation are just a few of the reasons a claim could be rejected or denied.

To make sure your claims are 100% ready for submission, you’ll want to consider the following additional resources (if you haven’t already):

Certified medical coding and billing staff to review claims and correct errors
An integrated EHR and practice management solution that automatically suggests relevant ICD-10, CPT, and modifier codes
A practice management system that provides the flexibility to implement custom scrubbing rules for claims

How the ModMed BOOST team can help:

Our Business Operations Services team uses Modernizing Medicine^®‘s Practice Management system, which has a 98% first-pass claim acceptance rate, to help your practice manage claims processing and submission. If a claim doesn’t go through clean the first time, our team will work with you to revise and resubmit it for processing.

#3. Prioritize Your Medical Billing Process with Outstanding Patient Claims

As much as you’d like to focus on 100% of your outstanding claims, 100% of the time, most busy practices simply don’t have the bandwidth to do so. That’s why it may be sensible to start with claims that are easier to submit and have a higher probability of getting paid.

You can also prioritize and sort claims by:

Claim amount
Common services and codes
Insurance companies
Those with missing information

At Modernizing Medicine, our Practice Management system structures the data you’re looking for within dashboards, task lists or customized reports. It also supports advanced filtering, providing detailed views of your medical billing revenue cycle.

How the ModMed BOOST team can help:

The ModMed BOOST team can help take tedious claims management processes off your to-do list, by working with you to help resolve rejections and denials. We also provide statements and field inbound medical billing questions to help with patient collections.

#4. Collect Your Patient Copayments Up Front

Collecting copayments, coinsurance, and deductibles at check-in or checkout at the time of service can help improve cash flow and shorten your medical billing revenue cycle.

Modernizing Medicine’s Practice Management system can assist your front office staff with the patient collection process. With built-in insurance eligibility verification, your office staff can easily communicate and collect the patient’s responsibility before their appointment.

How the ModMed BOOST team can help:

In addition to insurance eligibility checks through the integrated practice management software, the ModMed BOOST team provides patient statements, answers patient questions and processes payments.

#5. Charge Patients For Missed Appointments

According to a report by the Medical Group Management Association (MGMA), the average no-show rate for most medical specialties is 5 percent. Yet, only a quarter of the practices surveyed reported charging a no-show fee.

Modernizing Medicine’s Practice Management system can assist with communicating and enforcing your no-show policy – and help prevent missed appointments before they happen.

For example, Modernizing Medicine’s Practice Management software can help you:

Send out communications that speak to your no-show policy
Deliver appointment reminders by text, email, or an automated phone call
Flag frequent no-shows for additional patient communications

How the ModMed BOOST team can help:

When you outsource your billing and claims management process to our dedicated revenue cycle professionals, your staff will have more time to work with patients and enforce your policies.

#6. Review and Adjust Your Fee Schedule

Each year, insurance payers adjust their fee schedules for covered services and procedures, and it’s vital that you keep up with these changes to make sure you are maximizing patient collections.

There are many different approaches to setting fee schedules, some of which include:

Set your fee schedule at 2-3 times the Medicare rates.
Perform an in-depth analysis of practice costs for each procedure.
Reference the Medicare resource-based relative value scale (RBRVS) to estimate physician efforts and costs.

How ModMed BOOST team can help:

The ModMed BOOST team continually monitors financial metrics and trends. One of the metrics they track is payments as a percent of your charges. This measurement can help you identify opportunities to adjust your fee schedules and ultimately collect what you’re owed.

#7. Understand Your Insurance Carriers

In the insurance world, they’re called payers, and if you don’t abide by their rules, you might not get paid.

Here’s what you can do to help ensure that you’re playing by the rules:

Run insurance eligibility – When done in advance of your patient visit, it can help identify potential insurance issues before you’ve provided any services.
Meet filing deadlines – Most health insurers will have deadlines for claims submissions. You might have 30 days or two years.
Update your fee schedules – Setting your fee schedule above the highest amount paid by your top insurance providers helps you collect the maximum reimbursement for the treatment or service provided.
Handle denials and rejections – As your practice works to resolve unpaid medical claims, you may start to notice patterns among your payers, and adapt to them
Keep up with your A/R – High A/R means you may not be getting paid for all of your work you’re putting in.
Identify reimbursement schedules – This is key to understanding how to prioritize unpaid claims.

How the ModMed BOOST team can help:

Our experienced billing specialists are available to help you manage your claims submission, address rejections and denials, and tackle your A/R systematically while allowing you to get back to your patients.

#8. Transfer Patient Balances and Send Statements

Once you know how much of a patient’s bill will be covered by insurance, it’s time to bill the patient (ideally, this should happen while they’re still in the office). However, some practices overlook this crucial step. To help facilitate this, you can send out paper statements or invite your patients to log into the patient portal and view their bill online after the visit.

These actions will help encourage on-time payments and improve cash flow.

How ModMed BOOST team can help:

The ModMed BOOST team can send out patient statements, as well as provide a hotline for your patients, to answer any questions and help them understand their payment options.

#9. Focus on Your Outstanding A/R

Accounts receivable (A/R), is the outstanding amount owed to your practice for billed services.

Your A/R is continuously changing, so you’ll want to monitor it regularly to ensure that it doesn’t go out of range. Ideally, you should analyze your collection backlog every week and do a more in-depth analysis of your A/R overall each month.

Here are some features of the Modernizing Medicine’s Practice Management system that can help you and your staff improve your billing workflow and keep up with your A/R:

Automated health insurance verification – checks patient benefits and financial responsibility so your staff can collect patient balances upfront.
Patient balance estimates empower front office staff to collect patient payments at check-in and checkout.
Custom dashboards and reports allow you to easily monitor A/R analytics based on age, billing date, service date, health insurance, and more.

How the ModMed BOOST team can help:

The team can help you with your A/R, claims processing, denial and rejection resolution, and assistance with patient collections. In other words, they help you collect what you’re owed.

#10. Understand and Improve Your Net Collection Ratio

To calculate your net collection rate, divide the net sum of all payments by net charges over a specified period (like 90 or 120 days). Then multiply that number by 100 to get the percent.

If your practice isn’t meeting the net collection ratio benchmark of 96%*, your billing department should take another look at:

Denied Insurance Claims – A high denial rate indicates a disconnect between your practice and the insurance companies you work with the most.
Patient Collections – A high number of outstanding patient balances could indicate that your payment due dates are unclear, or your method of collecting payments isn’t proactive enough.
Outstanding Insurance Claims – If your claims aren’t getting paid in a timely fashion, you may need to dedicate more time or resources to follow up with your payers.

Modernizing Medicine’s integrated EHR and Practice Management system can simplify patient collection while analyzing your practice’s overall financial health.

How the ModMed BOOST team can help:

As part of our white glove service offering, client advisors meet with practice leaders monthly to review your financial metrics and identify areas for improvement. Net collection ratio is one metric that is monitored and compared to industry standards.

#11. Benchmark Against Industry Standards

Once you know where your practice stands in terms of financial performance, you’ll want to benchmark your data against practices that are similar to yours.

Key financial metrics to compare include:

Day Sales Outstanding

What is it? This metric tells you how much time it takes to collect payment. To calculate it, divide your outstanding accounts receivable (A/R) by the average sales per day – over a month or more.

Industry benchmark: According to the Medical Group Management Association (MGMA), DSO of 45 days or less is ideal.^*

First Pass Clean Claim Acceptance Rate

What is it? The percentage of medical claims processed by insurance the first time, without requiring any edits or corrections.

Industry benchmark: According to the Journal of Medical Economics, your practice’s clean claim acceptance rate benchmark should ideally be over 90%.

Claim Denial Rate

What is it? The percent of your medical claims that health insurance companies have processed and denied payment.

Industry benchmark: According to The American Academy of Family Physicians, the industry-standard is between 5 and 10% — less than 5% is ideal.

Net Collection Ratio

What is it? Measures how successful you practice is at collecting charges for billed services.

Industry benchmark: MGMA reports that practices with a net collection ratio of 96-97% are effective at collecting charges, while a score of 95% or lower indicates room for improvement.^*

Accounts Receivable (A/R) > 90 Days

What is it? The outstanding balance owed to your practice for billed services. It is common for practices to analyze metrics that are more than 90 days past due.

Industry benchmark: The MGMA benchmark A/R for greater than 90 days is between 12% and 15%.^*

How the ModMed BOOST team can help:

As part of our white glove service, a ModMed BOOST advisor continually monitors your practice’s financial performance, reviewing metrics with your practice and helping your business identify medical billing process improvement. The ModMed BOOST team works with you and your staff to help improve your revenue cycle, while taking care of manual tasks so that you can spend more time with your patients.

Our Practice Management technology and Business Operation Services help your entire office run more efficiently. Working seamlessly with our EMA^®EHR system, ModMed BOOST can help you solve billing challenges, put the right processes in place and gain more visibility over your entire medical billing process.

We can even help you speed up your revenue cycle, so you’re free to get back to what matters most of all—patient care.