Medical billing is even daunting to a new or expanding healthcare practice, but knowing the ins and outs is the only way to ensure your revenue stream is not disrupted. When billing procedures are done properly, providers receive payments sooner, denials are minimized, and administrative stress is reduced. This is an entry-level tutorial on medical billing, the flow of claims in the revenue cycle, and why a significant portion of the practices in the United States opt to outsource to a specialist such as Acuity Health Solutions.
What Is Medical Billing?
Medical billing refers to the act of accepting the care you offer, which is services, procedures, and diagnoses, and transforming them into claims that can be billed to insurance companies. The objective is simple: ensure your practice is paid properly and on time.
The steps involved must, however, be accurate and detail-oriented. Any mistake made in the process may lead to payment delays, rejected claims, and compliance problems. An effective billing procedure not only secures your revenue but also enhances the entire patient experience by saving on confusion and unexpected bills.
How a Claim Moves Through the Revenue Cycle
Revenue Cycle deals with booking a patient from the point of payment to the final payment. By understanding this flow, practitioners can understand the points at which problems arise, and this is how they can be avoided.
Eligibility Check and Scheduling of Patients
This begins with gathering patient data and checking insurance status, copays, deductibles, and prior authorizations. This measure is very important in preventing denial. When this is not done prior to eligibility, claims are more likely to be refused.
Coding & Charge Capture
The providers document the visit, and the certified coders translate the procedure and diagnosis into CPT, ICD-10, and HCPCS codes. Full and proper charge capture will be in place to capture all billable services. The impact of missed charges on revenue is realized.
Claim Submission
Upon coding, the claim is examined to see if it is accurate and is electronically sent to the payer. A clean claim does not have any errors or omissions. Clean claims accelerate the reimbursement and minimize rework.
Payer Review & Adjudication
The insurance company examines the claim and decides what they are going to pay. The outcome can be full payment, partial payment, or denial.
Accounts Receivable (AR) Follow-Up.
This phase will see the monitoring of outstanding claims, fixing of problems, filing of appeals, and following up with the payers until the claim is settled. Powerful AR processes minimise claims of ageing and enable predictable cash flow.
Patient Billing & Payments
Any patient responsibility is billed after the insurance has made the claim. Effective communication will enable the patients to know clearly what they are expected to pay and enhance the collection of payments.
Why Billing Errors Cost Practices Money
Even minute mistakes can result in significant revenue issues. Some of these mistakes are not fully filled in patient information, a lack of previous authorizations, wrong coding, and false eligibility checks. Such problems cause unnecessary refusals that require more time and effort to resolve. This is because thousands of dollars are wasted each month, as many practices do not pursue denied claims in a timely manner or at all. Avoidable revenue loss is mainly due to inconsistency, inaccuracy, and inadequate training.
How Outsourcing Simplifies Operations
Many healthcare practices prefer outsourcing their billing to professionals such as Acuity Health Solutions because it enhances efficiency and reduces administrative stress. Outsourcing offers:
- Higher clean-claim rates
- Faster reimbursements
- Good denial control and appeals.
- Improved AR follow-up
- Correct documentation and coding.
- Effective reporting that includes performance measures and KPIs.
By partnering with an RCM provider, the provider can remain dedicated to patient care while the billing team handles the tedious, time-consuming tasks behind the scenes.
Medical Billing is not a difficult process. When practices know the stages of the revenue cycle, which are eligibility, coding, clean claims, and AR follow-up, they can diminish the denials and maximize the reimbursement. By collaborating with an established billing team in the United States, such as Acuity Health Solutions, it is possible to establish an efficient, predictable, and smooth revenue cycle that enables long-term practice expansion.
