Revenue Management Tip #2: Review Claims Before Submitting

How people, technology and services can help improve claim denial and rejection rates for your medical practice.

This post was originally published on February 28, 2019 and updated on September 6, 2019. 

As a physician and medical practice owner, you have to split your attention and focus on overseeing all of the clinical, operational and financial operations of your practice. Long-term success depends heavily on the efficiency of your financial operations. Each month, I will provide a revenue management tip to help guide you down the path of financial success for your business, so you can refocus your time on your patients. Last month’s tip revolved around collecting patient balances in the office.

This month I’m focusing on the fact that U.S. doctors lose an estimated $125 billion in revenue each year to poor billing practices. Up to 80% of medical bills contain errors that oftentimes result in rejected or denied claims.¹ Therefore, reducing errors in your claims processing is a critically important component of your healthcare revenue cycle. Your medical billing operations should incorporate a close review of all claims before submitting to avoid risk of denials or rejections during the reimbursement process. Incorrect patient or provider information, incorrect or missing codes, duplicate billing, lack of documentation and other errors can impede claims processing and delay your payment.

Hire Certified Billing Staff

Your billing staff should ensure you are properly reimbursed for your services. Hiring certified medical coding and billing managers can help your practice effectively review and correct claims prior to submission. Additionally, certified medical billing and coding specialists can stay abreast of coding changes and new protocols that can impact your medical billing and reimbursement. Investing in staff members who are specifically trained to manage your medical billing process act as dedicated resources who focus the time and energy needed to create and review claims for accuracy and follow up with payers throughout claim processing. This will help ensure claims are submitted correctly the first time to facilitate full, faster payment, while avoiding the costly effort of claims re-work and resubmission.

Adopt Robust Practice Management Technology

Adopting a practice management solution that offers intelligent claims evaluation technology can further help generate claims that are going out clean. Modernizing Medicine’s Practice Management system contains an automated built-in claims scrubbing process.

As you document a patient visit in EMA®, the applicable E&M, CPT, ICD-10 and modifier codes are suggested automatically. When the visit is finalized in EMA, a bill is automatically created and transferred to Practice Management, where the claim is created.

The intuitive user-interface makes it easy for your billing staff to review and modify claims as needed. The system gives you the flexibility to create custom claim scrubbing rules for your practice by payer, provider, location, CPT code, ICD-10 code or modifier, allowing issues to be addressed even before submission to the clearinghouse.

Once your office staff submits the claim, the clearinghouse scrubs each claim based on payer rules, so before it even goes out to the payer, the clearinghouse can send it back to your practice management system with a prompt that reads, “this is what you need to modify.”

Tom McNeil, CEO, shared, “Using Modernizing Medicine’s Practice Management system’s claim-scrubbing logic, we achieved a 99 percent payer acceptance rate. This not only expedites the A/R cycle, but minimizes re-work within our billing team.” By maximizing claim scrubbing capabilities, you and your office staff can shorten the revenue cycle. If claims go out clean on first submission, turnaround time for payment is positively impacted.

Opt for a Third-Party Comprehensive Billing and Collections Service

Some medical practices may not have the budget or resources to staff certified medical coders and billers. On top of that, hiring someone with the right training and qualifications can be an arduous task. If you face some of these staffing challenges in your practice, you may want to consider utilizing a third-party advanced medical billing service to handle your claims management and collections, allowing you and your staff to focus on patient care.

modmed® BOOST provides medical billing and collections services for dermatology, ophthalmology, orthopedics, otolaryngology and plastic surgery practices. Medical billing specialists dedicated to your practice work seamlessly within your Practice Management system to help process claims, including an additional claims review step before submission to the clearinghouse. These multiple scrubbing steps help you submit cleaner claims to help you receive reimbursement faster. Should a claim be rejected or denied, our modmed BOOST team will work with your practice to revise and resubmit the claim for payment. Your dedicated client manager will monitor the overall financial health of your practice, analyzing changes and trends in reimbursement and providing you with a monthly assessment of your financial performance. modmed BOOST can help improve your financial and operational performance, while freeing up time and resources for you and your staff.

Jessica Kappelman, MD, MPH, said, “The all-in-one suite, with EMA, modmed BOOST, is worth the investment to have the confidence that my business is taken care of. I trust that Modernizing Medicine is looking out for the financial health of my practice, and I have confidence that I am earning what I deserve.”

¹Healthcare Business and Technology

Patrick DeAngelo

SENIOR VICE PRESIDENT AND GENERAL MANAGER OF BUSINESS SERVICES