As a medical office, your priority is always patient care. However, you can’t provide high-quality patient care without proper funding. This means that although patient care comes first, you still need to place emphasis on efficient payment collection to keep your clinic financially sound.
By practicing efficient medical billing and collections in St. Petersburg, your patients will reap the rewards of visiting a clinic able to provide the quality medical services they deserve.
Proper billing requires skilled and experienced staff who understand the process including coding, billing , and collections. This should be a seamless process that allows collection to take place as promptly as possible as well as accuracy in coding to ensure delays are not encountered due to errors. Having clearly defined roles in hand with a well thought out process will allow you to keep patient’s billing managed properly so focus on patient care can be improved.
Coding is the first step when it comes to medical billing and collections in St. Petersburg. It provides standard codes that allow you to have uniform billing. The codes used are recognized across all areas of medical care including insurance companies, medical practices, and relevant care related agencies. Your medical coder must ensure that the codes they use are provided correctly to the insurance companies or “commercial payer” as well as the Centers for Medicare and Medicaid (CMS). All parties must recognize the codes because they all tie together. The diagnosis codes will prove any following procedures, tests, or treatments are warranted.
The next important step in medical billing and collections in St. Petersburg is having a process that accurately collects insurance information. Discrepancies and small errors in a patient’s insurance information can lead to all kinds of issues and delays. These places demand on your billing team. Before a patient is even seen, your team needs to collect insurance information so all parties involved in treatment will understand the costs involved with treatment and care. Patients will want to know how much of the costs associated with their care will have to be covered by them personally.
When patients are handed a bill they don’t understand or that they weren’t expecting it can delay payment. Your team can verify insurance information upfront so they can explain all associated costs with the patient.
In the case where a procedure is not considered standard, preauthorization is strongly advisable. When preauthorization is obtained well in advance of treatment, the patient will understand what they will be required to pay if the full amount is not covered by their benefits.
It is also advisable that payments to be made by the patient are requested prior to booking whatever treatment or tests are required. If the situation involves copays, advanced payment will help avoid collection issues when treatment or tests have already been performed.
Allowing past due amounts to grow is very ineffective and inefficient. The longer a patient takes to pay, the less likely it is you will ever receive payment. It costs more money to process late payments as staff must make more calls and have to make arrangements for payment plans, etc. If you get things right from the start with correct coding, insurance verification and upfront payments for copays, you’ll be much further ahead.
One of the most common issues with medical billing and collections in St. Petersburg is claim denials. When you take the time to verify everything and discuss treatment payment with your patient, you greatly reduce the risk for denied claims. If you do run into denied claims by a commercial payer your team can appeal the decision and ask for clarifications or explanations. The patient themselves can also make an appeal. However, in this case, the patient might be left holding the bag for the outstanding payment.
A denied claim can happen for many reasons. Often it is just miscommunication or misunderstanding about coverage between a patient and their commercial payer. Patients are often unwell at appointments and might not be paying attention to everything happening when they arrive at your office. They might also think they have better coverage than they actually do.
Again, this is why getting everything confirmed upfront is so important. It avoids payment issues as well as added stress on your staff, not to mention your patient who is already feeling unwell.
If you can take action at the very first appointment your patients will understand their costs and what they are expected to cover.
Proper coding avoids delays and changes by explaining clearly what treatment/tests are required based on the diagnosis. You can avoid collection situations by getting payments upfront and confirming both the commercial payer and patient understand what they are responsible to cover.