Better Billing Today Podcast
Better Billing Today is the show for all things billing! If you're involved in collecting money, charging customers & members or medical patients then this podcast is for you. On this show we cover topics related to Revenue Cycle Management, PCI Compliance, HIPPA Compliance, Accounts Receivable and more!
In this episode we discuss 4 strategies that can help your medical practice recover uncollected revenue.
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Welcome to Better Billing Today. My name is Adam. I'm your host, and on this show we're talking about revenue cycle management, medical billing, technology compliance, all things related to revenue management for small hospitals, doctors' offices and clinics. And if you're a technology enthusiast wanting to explore automating payment processing and looking at new technology, we cover those topics as well.
Today we're covering an article that came out on Vox, and the title of the article is Never Pay a Medical Bill without asking these questions first. For those of us in the revenue cycle management space, we need to be aware of what's happening for the consumer and what content they're digesting because they're going to start asking better questions.
And thankfully they are because we want to help them. We are in the customer service business. If you're in the billing department, you're not just in the accounting department, you're in customer service, and our job is to help the patients have a better. Patient experience. I wanna bring up a few of the questions that they're being coached to ask in these mainstream publications.
And one of them is, Getting upfront pricing, transparent pricing before any procedures are given. In fact, since 2021 if you're working in this space, you know that the federal law has required hospitals to post transparent pricing. So before that patient is getting that service from the provider, they're being coached to go to the website and get the rates, the insurance rates, and the cash rates.
But according to PatientRightsAdvocates.org less than 25% of the hospitals in the US are actually posting their prices online, but our patients are going to be asking for these things. So as revenue managers, we have to be engaging leadership and get these prices on the website and be compliant with federal law.
This also means that there's additional training for your billing staff, and that means your billing staff needs to be prepared to have conversations with the patient and give them the information they need to make the best decision while letting the patient decide if it's better to use the insurance or to pay out of pocket.
And if you haven't taken a look at Healthcare Blue Book and for health consumer, your patients could be price shopping your services against these blue. And let me read you just one section from this article. If the patients are uninsured, the healthcare provider must put in writing a good faith estimate.
And the article actually says here Don Green, the operations manager at a medical billing advocate service resolve says These estimates include the cost of procedures and any associated cost, like lab test, anesthesia for surgery, and should your. Total $400 or more over the estimate. You can file a dispute with the provider, but these disputes start with the billing department, and that means you have to be training your billing staff to have these conversations and know how to walk through a dispute and compare a good faith estimate against an actual invoice that the patient has received for those services, and they need to know how to navigate that conversation and give that.
That customer service and help them get that bill resolved, whether it's going to be a price change or getting them to pay the full amount because of these other add-ons that were unexpected. Again, it is a good faith estimate. So teaching your billing department how to review those invoices against those good faith estimates and having productive conversations to again, help create a positive financial patient experience.
I can't say it enough. Communication and clarity and customer service are at the heart of the financial patient experience because when they have a service, they obviously are not signing up for this because this is an elective thing that they want. This is an a life event that they have to deal with, and the last thing they want is somebody on the other side of the phone who isn't empathetic to the service, isn't helping them solve the problem and doesn't care that there's a discrepancy.
Between their bill and what they thought was gonna happen when they got the service from this particular provider. If the price was more transparent, they might have chosen a different provider, but we have to help them overcome these discrepancies in these bills. The article goes on to coach the consumer or the patient, how to negotiate the medical bill, how to ask better questions.
I encourage you that if you have a billing, If you're a revenue manager, you need to be sharing these articles with your staff so they know, show them these articles, let them know what the consumer or the patient is being taught on these major platforms about how to have better conversations and better questions with them.
Your billing staff, and if you're the provider and you're the revenue manager, and you're the medical coder and the medical biller, and you're chasing up the deductibles and you're having conversations with the patient, Wearing your customer service hat, you need to be reading these articles or partner with a service that.
Ready to have these conversations with patients and is up to speed on not only just the requirements of medical billing on a compliance standpoint, not only from a security standpoint, but also making sure that we're having healthy, productive conversations with the patients and really giving that on-brand experience for the entirety of the process. From check in, to check out from service to payment all the way through.
And if you joined us last week for our last podcast, We talked about the biggest expense that a healthcare provider has is uncollected revenue. I even gave you a handout called Find $5,000 in 15 Minutes. This is a short guide on where to go in your office to find.
Uncollected revenue. So we left off on a few of those tips. I've got a few more for you today, and one of the tips is not billing for services rendered. If you're in the billing department, how do you really know that every service that was rendered made it across your desk so that you could create the claim, batch it, and send it to the insurance company.
There are ways to verify this and we give you some tips on how to. And the other way that you're losing revenue is using incorrect coding, which also leads to denials, which is number six, not following up on denials. So why are you using the wrong codes? Are you training your staff that the policies have been changed and that the codes are updated?
Are you making sure they understand all of the different nuances of this code and these modifiers, and making sure they understand that these are the new standards for how we're doing things. And it's not just the same old. The medical billing industry is constantly updating and laws are being passed.
All the time that affect what we do on the ground. So make sure you're continuing to coach your staff on the latest policies and procedures. Again, following up on denials it's low hanging fruit. You've done most of the work, and I know it's a pain, but why isn't it that we're teaching our staff to follow up on denials because that is money that's owed to the practice.
And not every claim is fully denied, right? We have some claims that are partially paid and your staff needs to know how to run the report to find the re, the claims that are partially paid, and just get on the phone with the insurance company and find out what it was they didn't like. And if you can't get that one collected, just make sure you.
Do it better the next time. But every time you have denial we use this as our training basis. Every time you have denial, this is a learning opportunity. Not only do you have to get it collected, but you actually need to implement the lessons learned in the onboarding and training of your billing staff.
And this is a constant feedback loop where you think you've covered all the material you need to. But you get a denial, okay, what did we miss? Okay, we gotta talk to that person, get them trained, get them to understand that this is the modifier, this is the code they were supposed to use, and this is the reason why they missed it.
And last, but certainly not least, using older coding standards. Most of us are not using ICD 9 anymore. We're moving on to ICD 10. And you probably know all of those codes by now, the ones that are specific to the practitioner that you're supporting. But only in the last couple of years did we have one for 2021, CMS revised the EM coding guidelines.
So if you're still using the guidelines from before 2021, you're gonna get some denials. You're gonna have to do some of the work twice. But again, once you have that first denial, it's hard. It's like you don't want to confront it. You don't want to. Call the insurance company, ask them those questions, but again, we're leaving money on the table.
We're missing a chance to train our staff better and create a smoother process, not just for the patient, but for our staff. We owe it to our staff, to our providers to understand these rules, these guidelines. And not only understand them, but get our team to work well and work smoothly and entering these codes correctly.
And I can tell you how great it is to have a team that's dedicated, not just to customer service and the patient financial experience, but our own financial experience as well. We owe it to ourselves to have a smooth operating system inside our office just like the human bodies. Working well together with different organs.
This billing department has to function well with service and front desk and the patient and keep this organism, working well. So take advantage of the tools that are coming out that will help you create a better billing department. So if you're an office manager also wearing the hat of revenue manager or a billing specialist, or you're the doctor doing your own billing it is hard to keep up with these changes and it's hard to justify.
Following up on these denials, but again, it's free money that you're leaving on the table and while you're going to see another patient an outsourced billing company like ours could be doing those follow ups for you. And at Spark, we believe that being distracted by billing problems is just plain wrong because there are so many people that specialize in this one thing that.
The people in the office, including the doctor, need to be focusing on the patient experience, setting appointments, following up on these appointments, making sure that they remember their appointment, and that you're not scheduling and having vacancies when you could just be replacing it with another person.
But if you're worried about billing some of those higher value services or those high value added touchpoints, don't get done in the clinic or the office if you wanna schedule a call. Go to our website, BetterBillingToday.com. Just check out our services that we have to offer and we're here to help you, give you plenty of free resources to improve the billing department of your clinic or your practice.
And provide some consultations, give you some audit worksheets to help you find the holes, the gaps in your practice that are leaking money from the operation. And with that, I wanna wrap up our show. This is Better Billing Today. I'm your host, Adam Welchel from Spark Billing, and this podcast again is for the revenue managers, the office managers who want to create a better patient financial experience.
Have a great day.
News Article: https://www.vox.com/even-better/23661759/reduce-health-care-costs-medical-bills
Free Guide: https://sparkbillingservices.com/5k-in-15-minutes
Have a billing story or question to share? Send them in to email@example.com
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