How a Real Revenue Cycle Pro Can Help Your Practice - TRIARQ Health

All medical practices need to collect the income they are due to keep a positive revenue flow. While this may seem like a fairly simple proposition, making it a reality is anything but. To lighten the load for everyone in the, you may want to consider outsourcing to a revenue cycle pro to get everything done correctly and promptly.

Having confidence that the right amount is billed to the right places requires the attention of everyone on the staff. The doctors and other practitioners must be sure to enter the patient’s information properly. This means that not just the specifics of their diagnoses and treatment, but also the patient’s name, address, insurance information, and demographics, must be entered exactly. Failing to get these details right can result in delays and possible nonpayment by the insurance company or patient.

Outside of the exam room, the burden of making sure everything is handled correctly falls on the biller. They must ensure that all the billing codes, plus any modifiers, are entered correctly, or else the insurance company will not pay the claim. It is also their responsibility to keep a watchful eye on any outstanding claims to be sure the insurance companies are paying when they are expected to. The biller is also the one who must reach out to insurance companies if there is a problem with a claim, getting the payment situation rectified.

Those at the reception desk must also do their part. They are responsible for collecting copays and making sure that all payments are reported and filed correctly. If the patient is going to be billed for their services or copays, the receptionists must also be sure to take note of that so the biller can send the appropriate invoice to the patient.

This all takes a great deal of work and coordination, and it must all be done correctly if the office is to maintain a steady revenue stream. This is why medical practices should seriously consider bringing in a revenue cycle pro.

Revenue Cycle Management: How a Medical Biller Spends Their Days

Medical billing (or, revenue cycle management) is a big undertaking. It requires the ability to tackle multiple tasks at the same time, thrive under pressure, and have a clear understanding of their role in keeping the medical practice in the black.

Here’s a look at the responsibilities of their daily grind and some of the specific obstacles they may face to achieve their goal of collecting all of the revenue that the practice is due to receive:

Responsibilities

To meet the needs of their practice, a medical biller must assume many responsibilities. Accomplishing these tasks will require a wide range of expertise and experience, as well as the ability to keep track of every detail. Some of the biller’s responsibilities include:

• Submitting claims to insurance companies
• Preparing and sending invoices to patientsStaying on top of claims, both paid and unpaid
• Resolving nonpayment issues, both with the insurance companies and with patient collections
• Researching why a claim was rejected and, if possible, resolving the issue
• Ensuring that all procedures and services given to patients are recorded and billed for
• Conducting audits
• Training, and reminding, staff members how to properly handle their role in the revenue chain
• Conducting reviews for Medicare

Accomplishing all of these tasks requires much more than just an understanding of accounting. Medical billing also requires that billers have experience with the way insurance companies work and a firm grip on the coding system used by them to submit claims. A biller must also be able to communicate clearly with the insurance company employees, their fellow staff members, and patients while maintaining a calm and professional manner.

Medical Billing for Specialists

Working as a revenue cycle pro in a specialist office requires some more specialized experience and knowledge.
Here are some of the extra requirements to be a successful biller in a specialist’s office:

Billing Woes

The more specialized the medicine, the more complicated the billing procedures. The medical biller must be able to untangle the knot of insurance requirements to be sure that the claims get paid on time. For instance, the common treatment for many types of cancer, chemotherapy, requires the use of several different, very expensive drugs. The insurance companies will need very specific coding for the treatment and medications given and will often need extra layers of verification before they will settle a claim.

Patient Woes

A medical biller who supports an office where many of the patients are suffering from long-term ailments, or have very poor prognoses, have another set of hurdles to jump through. They need to be very careful when inquiring about unpaid invoices. They are not likely to receive a warm welcome concerning their payment follow ups if they make contact immediately after the patient has taken a turn for the worse or during special days like holidays or birthdays.
Still, these bills must be paid, so the biller must be aware of the patient’s condition and vital statistics, be able to be very tactful, and have a thick skin.

Patient Assistance

While a medical biller is not responsible for the health care of a patient, they can and should be able to offer them financial assistance. The biller should be able to offer the patient estimates as to how much a particular procedure or total treatment plan will cost them. Because paying for medical procedures is a heavy burden for many patients, the biller should also be able to offer a payment plan to cover the costs over time.