I have read many articles stating that healthcare providers leave trillions of dollars on the table with their healthcare claims. This is astounding and baffling at the same time. How could this be? I can tell you exactly how it happens. Healthcare practices do not have a system in place for the revenue cycle. Also, healthcare providers are not retaining talent to operate their billing systems.
It is imperative that healthcare providers get all the reimbursement that is due to them for their services. B.T. Elite uses the below system for our clients to ensure there is no money left on the table and for healthcare providers to be aware of the “number.”
Verify eligibility
Billing Consistently
Address Denials Weekly
Analyzing a monthly report
Verify eligibility
Verifying eligibility is not a guarantee of payment (that is the disclaimer that insurance networks give); however, it does ensure that you are servicing a client with active insurance for the specialty you are treating. Verifying eligibility will also let you know what the limits of the services are, so you are not servicing the client for free.
Billing consistently
If healthcare practices want to see consistent money in their bank accounts, then billing should be submitted every business day. If the healthcare practice is not submitting claims consistently, then money will not be available for expenses or payroll.
Addressing Denials
A healthcare practice submits claims, and they get denied. If there is not a system in place to address these denials consistently, then the healthcare practice is leaving money on the table. Denials can be as simple as the wrong date of birth for the client or as complex as the coordination of benefits. Denied claims are a part of the revenue cycle. They must be addressed.
Analyzing a monthly report
Most EHRs (electronic health records) have a vast array of reports that can be useful for the practice. A good practice is to download a monthly account report that includes the client's name, dates of service, insurance name, insurance payment, client responsibility, and any other areas that you want to analyze. The purpose of this report is to analyze what claims are paid or denied. This is important because it shows you the “numbers”.
To prevent being a statistic and leaving trillions of dollars on the table, adopt a system for your billing revenue cycle today!
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If you are a healthcare professional or a healthcare practice that can benefit from credentialing, billing, denial management, or training, Please contact to the healthcare revenue experts, B.T. Elite at...