Best Billing Strategies to Grow Revenue for Your Practice

More and more, taking care of business for large physician group practices means tackling increasing financial pressures from all sides - payers, providers, patients, government agencies, and others.

How you allocate your resources becomes increasingly important given how all the continuous changes to healthcare can threaten your budget. Striving for excellent patient care and outcomes always come first. A close second, however, is keeping revenue flowing and ensuring that you are collecting all that is due to your organization. 

The Productivity Costs of Billing

According to a Health Affairs study cited in TechnologyAdvice’s “Top 3 Best Practices to Boost Billing Efficiency,” almost 12 percent of physician net patient service revenue goes to pay for costs of ‘excessive administrative complexity.’ Interestingly, medical billing inefficiencies account for 74 percent of those costs. Time-consuming tasks such as preparing paperwork and contacting payers directly with questions about diagnoses, treatment plans, and prescriptions were cited as the reasons behind billing inefficiency.

Regulations and payer contracts are constantly changing, making medical billing and coding challenging at best. Among the trends affecting payments is the continued increase and shift towards patient responsibility.  As a result, bad debt is on the rise and practices are experiencing unprecedented revenue pressure. Staying ahead financially requires an unrelenting focus by your group administrator or billing services manager to adopt the latest and most effective billing strategies.

The best tactic to increase efficiencies in billing operations involves an attack on two fronts: Reducing days that claims spend in accounts receivable while revamping front desk operations that affect your accounts receivable. Regardless of whether you outsource your medical billing or process payments entirely in-house, here are three best practices for large physician practices:

1. Automate front-end processes.

MGMA states that best performing practices have 1.29-1.38 full-time equivalents per physician for front-desk operations. There are many tasks that must take place at the front desk so it’s imperative that you utilize every tool possible to create the efficiencies needed to keep costs down.  Verify patient insurance eligibility in advance to increase the likelihood you’ll get paid for your services. Implement a policy that 100 percent of all patients will have insurance verified prior to services rendered.  Standardize the process and assign one champion to be responsible.  This function should be performed prior to appointments. 

Streamline pre-certification processes so that front-desk staff is alerted in advance of such required authorizations.  Automate your system to flag missing authorizations and prevent claims from going with missing authorizations.

Automate appointment reminders.  Research shows the use of all three modalities is most effective -email, text, and phone. 

2. Collect from patients up front.

Collecting from the patient at the time of service is more critical now than ever with the shift toward patient responsibility.  In order to collect from the patient effectively, there are several things you can do to ensure success in this area.  Communication is where it begins.  Clearly post your medical group’s policy to collect each patient’s financial responsibility at the time of service. Posting a sign to this effect in each waiting area will avoid surprises and make it easier for front-desk staff to request payment.  Train your staff on how to ask for the money at check-in.   Implement a credit card on file program so that patients can pay copay at time of service and opt-in for having their credit card charged once a claim is adjudicated.  Evaluate your staffing roles and make sure that front-desk staff members are comfortable having conversations about money.  Train your appointment schedulers to clarify each patient’s financial responsibility before they show up at your medical group, increasing the chances you’ll collect the precise amount they owe for their copay or co-insurance.

3. Proactively Slash Your Denial Rate.

Although the overall trend is a decrease in claim denial rates over the past few years, the transition to ICD-10 coding could temporarily reverse these gains. When CMS ran a recent test of ICD-10 claims processing, 12 percent of claims were denied. To be fair, the majority of denials were not caused by miscoding, CMS said. Regardless, the ICD-10 transition period could place a large burden on your staff to process the additional claim denials across your large practice.  Implement a “Robust Rules and Claims Engine” that is ICD-10 ready and checks for current procedural terminology to diagnosis to modifier relationships, commercial unbundling, medically unlikely, global surgery periods, duplicate charges, and partially- or completely-unbilled services.  This helps you correct claims at the source and early, before they even get to the payer.

Additional Strategies

It’s unlikely you’re the first C-suite executive managing a medical group of your size and specialty to face revenue headaches related to billing. One of the first steps in solving your revenue headaches is to identify where the problems exist.  Perform a full financial assessment of your performance by comparing key performance indicators (KPIs) to industry benchmarks.  These KPIs can tell you a lot about your practice, identify areas that need improvement, and, most importantly, how much (if any) money is being left on the table.  Consider outsourcing if you haven’t already.  A survey conducted by MGMA in 2013 showed that 73 percent of practices who outsource realized higher collections and 59 percent saw a decrease in lost/denied claims. Work with a vendor who will help you explore this as an option by helping you with a financial assessment and cost analysis to see if this option makes sense for you.  Also check with peers who already outsource their complex billing processes if you’re considering the same solution. When you start researching third-party medical billing and coding companies, you’ll find a wide range of options. In addition, outsourced billing services often cost less than employing a full-time billing specialist in your office and can allow you to focus more energy on front-end operations if there is a need to do so.

Patti Peets is Director of Revenue Cycle Management at CareCloud.