How to Increase Revenue: Improve Clinical Coding Optimization

Clinical Coding OptimizationDue to changes in the healthcare industry, ENT practices and clinics need to split their focus between providing top quality patient care and finding new ways to improve account management. Customer service and effective billing practices are vital to the success of any medical practice. When medical billing and coding are done properly, claims are submitted to insurance companies for payment to continue providing patients with the care that they require. Preserving cash flow and limiting bad debts to ensure complete reimbursement for services rendered should be the mission of your billing department. This can only be achieved through clinical coding optimization and comprehensive organization every step of the way.

How to Improve Account Management

The business office for your medical practice needs to run like a well-oiled machine. Essential tasks are required to ensure that everyone gets paid, and patients get the care that they need. When new physicians are brought on staff, fast and accurate credentialing is required to ensure payment from insurance companies. When new patients get referred to your clinic, insurance verification is essential to make sure they get all of the options available for care and treatment. While most practices are excellent at focusing on providing medical care to their patients, they regularly fall short when it comes to account management, record-keeping, and clinical coding optimization.

Your front office staff is vital to the success of your medical billing and coding. It all starts with eligibility verification, registration, co-payments, deductible payments, and updated patient information to ensure everything goes smoothly within the revenue cycle. If your front office staff is not properly trained to have an understanding of why the requested data is so important, they might skip key steps that are required for payment. While most practices focus on medical billing and coding when it comes to training and support, these services are also needed for front office staff to improve account management and streamline the claims submission and payment process.

Why Eligibility Verification is Important

When a practice focuses on verifying the eligibility of patients with their insurance companies, they can effectively decrease the number of denials due to lack of insurance or coverage. When patients schedule an appointment, information can be verified at that time. Front office staff will then know before the patient even arrives if they have valid insurance or if they will need to discuss financial counseling issues before they see the doctor. This is beneficial both to the medical practice and to the patient, helping them to understand what their coverage is from the very beginning.

Once coverage is verified, front office staff can then be ready to collect patient payments. One of the biggest changes in the healthcare insurance industry was an increase in patient responsibility due to high-deductible health plans. If your practice knows that the patient has a co-pay or deductible due, they can make that payment upfront. Training your staff on how to effectively collect patient payments can drastically improve account management and reduce issues with cash flow. When all of the information is verified and accurate, it also makes medical billing and coding go a lot smoother.

Clinical Coding Optimization

If your billing staff does not know the proper codes for diagnoses, treatments, and procedures, they will not be able to provide you with effective medical billing and coding. This results in denied or rejected claims and can subject your practice to a negative reputation with the insurance companies. While fast and accurate credentialing provides the means for new physicians to work with healthcare insurance providers, it does not guarantee that there won’t be issues down the road if your billing department has poor skills for clinical coding optimization. Our team of consultants can help you evaluate the effectiveness of your billing department to determine whether training and support are needed there as well.

MD Pro Solutions can help you improve account management by offering:

  • a complete review of your entire medical billing solution
  • suggestions regarding the latest tools and techniques that can improve results
  • follow-up support to ensure that solid practices are being used to boost revenue
  • implementation of new methods and procedures designed to increase productivity
  • detailed monthly reports to improve management decisions through better data
  • outsourcing opportunities on an as-needed basis during training or to streamline the claims submission process
  • fast and accurate credentialing and recredentialing services
  • auditing and reviews – chart, surgical chart, annual fee schedule, and overall account management analysis

If you are interested in learning more about MD Pro Solutions and the professional services that we provide, give us a call at 508-946-1665. Our experienced and knowledgeable consultants can help you implement the best solutions to help streamline clinical coding optimization, increase results for medical billing and coding revenue,and improve account management across the board. Call today for a FREE initial evaluation.