Running a healthcare practice requires more than excellent patient care; it also demands strong financial management.
Ordinarily, the financial management process can easily be handled by in-house staff.
However, considering the rising regulations and complications of managing new healthcare models, it’s becoming more challenging.
Medical billers are professionals who take this task off many providers’ hands.
This article will explore how they function in keeping healthcare practices financially healthy.
Who Are Medical Billers?
When a healthcare provider has to manage insurance claims, receive reimbursements, optimize revenue cycle management, and handle other complexities, they mostly look to medical billers.
Medical billing is the process of generating healthcare claims to submit to insurance companies for payment of medical services.
The individuals responsible for carrying this out are medical billers.
In essence, without these professionals, providers may encounter difficulties in clearing their backlogs.
How Do Medical Billers Ensure Optimal Healthcare Practices?
We’ve hinted at some of the ways above; let’s explore them fully in this section.
Insurance Claim Submissions
Submitting insurance claims is a straightforward process, but it requires a lot of attention to detail that medical billers are more accustomed to.
Some of the main challenges providers face when submitting a claim are incomplete or inaccurate patient information, ABA billing code errors, eligibility issues, missing filing deadlines, and policy changes.
Medical billers are more equipped to encounter fewer such problems.
For instance, they cross-check data with issuer portals or eligibility verification tools to ensure they submit accurate filings.
Additionally, they often prioritize claims by submission urgency to ensure none slip through the cracks.
These factors make them better positioned to handle and deliver better results in insurance submissions.
Reducing Claim Denials
Claim denial is a well-encountered challenge in the United States healthcare system.
CNBC recently published some data from KFF, a non-profit organization focused on health policy.
According to this report, 73 million of 392 million in-network claims were denied in the US in 2023.
In 2021, it was 48.3 million out of 291.6 million.
These figures indicate a consistent increase in the rate of denials.
For healthcare providers, delivering care is only half of the process; the other half is ensuring they’re paid for their services.
If the risks of not getting paid increase, it’s only natural to seek support and professionals with a high chance of making this work.
Medical billers stand a better chance of helping you secure your claims because they are more skilled and adept at paying attention to the details that matter.
They are also quick to catch errors that might affect your claim.
Revenue Cycle Management (RCM)
Revenue cycle management is a process used in healthcare to manage the financial interactions from the point of patient contact to final payment.
The ultimate goal of this system is to ensure that payments for medical services are collected efficiently and accurately.
A significant financial commitment is required for healthcare management systems, encompassing everything from compensating staff adequately for their work to purchasing equipment, building facilities, and more.
If the financial part is balanced, everything else is automatically affected.
This explains why RCM is a priority for many providers.
However, because it encompasses several activities, including patient registration, insurance verification, medical coding, billing, claims processing, and claim collection, it’s mainly handled by medical billers.
Medical billers ensure that each stage of the cycle flows smoothly.
They confirm insurance eligibility, review claims for accuracy, and track outstanding balances.
By doing so, they prevent disruptions that could lead to delayed cash flow.
Ensuring Timely Reimbursements
Even approved claims don’t guarantee immediate payments, which is where medical billers come in again.
It’s their job to ensure timely reimbursement by tracking claims and following up with insurance companies to address any delays.
This consistency is critical to healthcare systems’ operations, especially as regards day-to-day expenses like rent, medical supplies, and equipment.
Navigating Regulations
The regulatory space in the US healthcare system is quite complex.
With constant changes in regulations, providers might encounter some challenges from time to time while attempting to ensure compliance.
For instance, the Health Insurance Portability and Accountability Act (HIPAA) imposes strict requirements on how patient data is handled.
Even minor lapses, such as sending patient information through unsecured email, can result in fines.
Providers must continually update their practices to align with evolving HIPAA guidelines on data privacy and cybersecurity.
Medical billers are professionals who are incredibly knowledgeable about the regulatory framework in the medical sector, making them best suited for undertaking the job.
Why Choose Skilled Billers?
Relying on the services of a skilled medical biller can improve every provider’s financial efficiency.
If you need help with any of the aspects of finance management we’ve highlighted above, you know who to look to.
However, it’s essential to do your research because hundreds of billing services exist, but the wrong choice can do more harm than good.
Prioritize licensed and regulated providers when researching.
