Avoiding Prior Authorization Denials

authorization denial

The prior authorization process haunts physicians and steals the precious time that could be spent on delivering quality care. Authorization denials hinder the care process by delaying the necessary service delivery.

The survey by AMA, i.e., the American Medical Association, reveals eye-opening statistics related to the burden of prior authorization faced by American doctors. As raised by prior authorization, the administrative burden of healthcare practices damages providers and slows patient care. According to the survey results, medical practitioners complete 41 prior authorizations per week and spend an average of 2 days per authorization. 88% of respondents deemed prior authorization a high hardship. 940 out of 1,000 physicians had to wait longer to assist their patients owing to prior authorizations (PA), and 8 out of 10 physicians indicated that their patients discontinued treatment during the delay.

Despite healthcare providers’ efforts to limit the amount of prior authorization claim denials, insurance companies continue to seek authorization for new consultations and procedures. Consequently, the number of denied claims has grown.

Do you also face difficulty related to prior authorization denials that disrupt the whole process of your workflow?

Let’s explore everything about authorization denial here. This article also discusses the types of authorization in medical billing.

Authorization Denial

In medical billing, “authorization” refers to the payer’s agreement to pay for specified treatments before execution. These services are also referred to as preauthorization and prior authorization. As the name suggests, the insurance provider must authorize the planned treatment or service. Failure to do so leads to authorization denial.

A variety of procedures require insurance company approval before they can be performed. When determining an individual’s eligibility for insurance, it is necessary to establish whether some services require prior authorization. The request will be made based on the patient’s health insurance coverage. Before granting coverage, insurance companies must approve requests for necessary medical treatments and benefit conditions. The preauthorization number must be included on the final claim form submitted following the treatment. Preauthorization is a component of medical billing that guarantees claims are processed efficiently and error-free. If there is no pre-approval, invoices are not paid.

Let’s find out the reasons for authorization denials and how to avoid them:

Claim without

1. Claim without Prior Authorization Number

Automated systems process the claim; if there is no prior auth number, the system denies it. A manual check is necessary to prevent authorization denial because of a lack of numbers. Double-checking the claim before submitting it is a good practice to save time and money.

2. Claim with only one Pre-Approved Service

A claim can be refused because just one of the claimed services was authorized beforehand. Personnel responsible for billing and coding must pay special attention to all services specified on a claim. Staff members responsible for billing and coding must cooperate with providers to ensure that providers understand which services require prior authorization and that all authorizations are received before the delivery of services.

3. Failure to Obtain Authorization Prior Treatment

It might be challenging when you need to treat a patient in an emergency and do not have time to seek pre-authorization. It is particularly significant when the patient’s condition is critical. In an emergency, payers are typically more likely to cooperate. On the other hand, they are typically quite rigid regarding non-emergency care.

4. Incorrect Claim Process

The incorrect processing of the claim by the payer leads to authorization denial. It is thus crucial to identify why the claim is wrongly processed. Warranting the reason is vital for preventing it. Identifying the error’s reason helps in the future by avoiding the mistake.

Incorrect Claim Process

Types of Authorization in Medical Billing

The common types of authorization in medical billing are prior and retroactive authorization.
Retroactive authorization requests the payers for approval after the treatment is provided. It is provided in emergencies when the patient is mostly unconscious and immediately needs the service.

Prior authorization, as explained earlier, is the approval made before the provision of treatment or service.
Medical practitioners and organizations can take several measures to make managing pre-authorizations easier. Since insurance companies modify the requirement for pre-authorizations depending on the standards, healthcare providers must remain current on the constantly changing clinical criteria for each illness state. When a patient orders a prescription drug in a manner that deviates from the norm, they are frequently required to receive prior approval from their health insurance company. In this case, preparing a list of the medications and treatments covered by each plan may be useful. These lists can also be incorporated into an electronic health record to alert physicians if they seek something that requires prior approval. Delays can be reduced in patient care by remaining up-to-date with insurer policies and formularies.

It may be advantageous to reduce the time doctors spend on the phone with insurance companies by designating and training individual staff to handle prior authorization requests. Having a Prior Authorization Certified Specialist on the team to aid with the administrative procedure is advantageous in multiple ways.

It is essential to establish effective documentation policies. The approval procedure will be a lot quicker if you maintain track of everything you’ve attempted in the past. Long-term maintenance of detailed records of past authorization requests can help facilitate renewals.

See Also: Billing And Coding For Pulmonary Procedures

Conclusion

Doctors strive to deliver the best possible care to their patients as quickly as possible while ensuring that their treatment options are effective, legal, and cost-efficient. Prior authorizations and claim denials are time-intensive procedures that might delay emergency medical care. However, outsourcing this complex process to Precision Hub (PH) can save time and energy. We are among the leading medical billing firms in the industry to handle all your prior authorization needs.

PH is an all-inclusive revenue management solution for the physician in the US. We aim to improve the financial health of your practice. Our experts are proficient in handling denied claims and preventing them in the future. It helps your practice generate more money.

With our years of experience in medical billing and coding, we build a solution to your clinic’s specific needs. Get in touch with our experts at Precision Hub to learn more about how we help manage authorization denial or support your medical practice.

 

Why Should You Hire A Medical Billing Company?

What is Medical Billing?

Healthcare providers often dedicate time, money, and resources for providing patients with the highest quality care. Receiving appropriate compensation for this work is a necessity for hospitals and other healthcare services to have enough capital to run their operations smoothly.

The lengthy process of managing accounts, billing, administrative work, and medical codes can become a great burden for hospital administration and staff. Hiring medical billers has proved time and time again to be the most effective strategy in today’s rapidly growing healthcare industry.

Healthcare providers often face a delay in receiving payments from insurance companies such as Medicaid, Medicare, and other insurance providers due to flaws in coding or filling forms. In an industry where $125 billion remains uncollected each year due to faulty claims, hiring medical billers can help take off the burden from hospital staff and administration. Neglecting the importance of outsourcing the critical billing procedures can be damaging, not only to the revenue management cycle of your practice but also to its reputation and the quality of service it provides to patients.

Continue reading to find out how hiring medical billers can benefit you immensely and run your practice as efficiently as possible.

1.Lower Labor Costs

Hiring in-house medical billers to work directly for the healthcare facility comes with several costs. Facilitating the process of hiring medical billers, paying salaries, providing benefits, additional training, etc., represent a high cost of doing business for healthcare providers and hospitals, also consuming much of their time before effective systems are put into place. According to a survey undertaken by The Commonwealth Fund, administrative costs per physician amount to $83,000 per annum, four times the amount incurred by a Canadian physicians.

Hiring a medical service provider and outsourcing this responsibility allows experts in medical billing to take over and shift the responsibility to those who have the necessary training, command, expertise and experience in this field. Medical billing companies will be responsible for incurring the costs of hiring, training, and paying the medical billers. Ultimately, this will reduce the number of claims being denied and promote greater reimbursement.

hire a medical biller

2. Increased Data Security

Patient data is constantly under threat as hackers and other cyber-criminals attempt to hack into and steal valuable patient data that can be used by insurance companies and other financial institutions. This information is very sensitive as it contains patient information, family information, addresses, patient history, diagnostic results, medication, and other important personal details.

Medical billing companies have often taken advanced measures and precautions to prevent this via the most up-to-date digital security software to protect sensitive patient data. This is done as billing companies follow HIPAA security rules and conduct risk assessments and risk management of all systems. Breaching Health Insurance Portability and Accountability Act of 1966  1996 (HIPAA) regulations can result in major fines and charges which can be detrimental for startups and independent medical practices.

Data security can also be enhanced with the use of innovative technology in the healthcare industry. For example, electronic health records (EHR) permit the practitioners to send, use, and monitor private and sensitive data most securely.

3. Decreased Logistics Costs

In-house medical billing staff requires their own office space, software, computers, and dedicated time from the HR department, all of which come with a substantial monetary price tag. Advance medical billing software requires experts to run and integrate it with currently existing systems in the hospital.

Hiring a third-party medical billing company shifts this responsibility and relieves the medical practitioner from this burden. Medical billers operate in their own offices, within their separate companies, and will use their own software. With a third-party medical billing vendor, the leftover space and business resources can be dedicated to therapeutic, diagnostic, pharmaceutical, and surgical facilities. Staff can also be hired or allocated to different areas of the practice where they may be of greater help and more productive.

4. Greater Revenue for Practitioners

Healthcare practitioners often bear substantial losses in revenues annually due to denied insurance claims. According to AARP, 1 in 7 claims is denied, resulting in over 200 million denials per day.  This occurs due to a broad spectrum of reasons. A few examples include incorrect medical coding, claim form errors caused by inaccurate information, missed deadlines, and insurance coverage issues. It is said that nearly 30% of all insurance claims are either ignored or denied.

In-house administration costs alongside errors in form submission that can result in long delays with insurance claims are also greatly reduced. An expert medical billing company increases the net revenue collection and corrects any deficiencies within the preexisting revenue cycle.

A greater revenue stream will allow the medical practice to grow and expand into other fields of medicine, improve patient care, or provide increased benefits to staff, to name a few advantages of outsourcing. Additionally, medical billing organizations can help identify areas of strength and weakness within your payments and collections system.

hire a medical biller

5. Streamlines Daily Billing Operations

Medical codes and insurance policies are ever-changing, and only someone deeply familiar with them can follow and apply them adequately. A coding specialist is well-versed and experienced in medical billing, coding, and the workings of the Affordable Healthcare Act, Medicaid, and Medicare.

Expert medical coders and billers can effectively identify compliance issues to limit insurance denials and allow the medical practice to receive greater cash flows and maximize revenues. Reclaiming rejected insurance claims will now be the responsibility of the hired medical biller, thus, reducing your stress and allowing you to dedicate more time to improving patient care or expanding your medical practice.

Maintaining and upgrading software solutions can take a large amount of capital and may also take up a lot of time. Outsourcing this responsibility of constantly updating and adopting newer software can be immensely beneficial in cost savings.

6. Greater Accountability and Reporting

Almost every medical biller relies on smart software that streamlines and automates the entire process of the revenue management cycle. This allows the greatest level of accuracy and prevents human error from interfering with the financial performance of your practice.

Hiring medical billers relieves the healthcare facility of most of the capital expenditures associated with acquiring and operating new software. Moreover, medical billing companies are fully compliant with HIPAA and follow all regulatory standards. A reputable medical billing company will also assist your practice in staying up-to-date with market trends, state laws and regulations, and codes.

7. Greater Financial Transparency and Analysis

Transparency in medical billing is a challenge. Healthcare professionals and hospital staff can help strengthen the patient experience greatly by streamlining the critical processes involved in billing and payments.

By hiring a professional medical billing company, a medical practice can easily reduce costs and delays. By automating and restructuring your billing operations, a medical billing vendor will be able to accelerate cash flows and improve operating margins. The subsequent operational transparency and financial efficiency will help you enhance the patient experience in turn, thus, enabling business success.

8. Reduced Errors in Billing

Hiring a medical biller will help you reduce potential errors in form submission and insurance claims. Almost four in five medical bills contain mistakes of some kind or the other, undermining your ability to receive timely reimbursement for services rendered from insurance providers.

A research study undertaken by NerdWallet reveals that nearly 49% of all Medicare claims contain errors. Other errors that practitioners should be cautious of include incorrect procedure codes, mishandled underpayments, missing information, and upcoding.

Hiring a medical billing company will help you prepare and dispatch error-free documentation and process insurance claims quickly. Relying on their billing experts means cutting down on coding and billing mistakes, better office management and compliance, and more savings per patient. Outsourced billers will help you save time in many ways, which you can then utilize more productively in enhancing your clinical practice.

See Also: The Importance Of Provider Credentials In Medical Billing

Conclusion

Medical billing is a complex field that is prone to errors and mismanagement. As the costs of managing medical billing processes in-house increase, so do the pressures of keeping up with multiplying rules and regulations in the healthcare industry.

Hiring medical billers can transfer this burden of administrative and financial duties from the medical professionals to those who are qualified and better able to handle them. If you are struggling with medical billing and need a reliable partner for assistance, Precision Hub provides the latest and most innovative tech-optimized medical billing solutions.

Let the experts take care of your outstanding claims and medical bills, while you focus on patient care! Hire a medical biller and let us handle all your billing, coding, bookkeeping, financial reporting and analysis.

A Complete Guide To Cpt Codes For Continuous Glucose Monitoring

cpt code for glucose

Are you planning on starting your medical practice? Are you unsure of where to begin?

Here is a deep dive into how the medical billing system works in the healthcare world, why it is important, and the CPT billing codes required for glucose. Knowing the right codes for glucose medical billing and coding accurately for your continuous glucose monitor (CGM) devices helps to boost your billing practice and reduces the risk of any loss of revenue.

How Does Medical Billing Work?

Medical billing refers to the process of submitting a claim, such as an insurance claim, and following up on it to receive full reimbursements for the patient care services rendered. While the process of medical billing may seem daunting at first, it consists of only eight simple steps. These include:

  • The registration of patients
  • The establishment of financial responsibility for patient visit
  • Keeping a check on the patient’s entry and exit
  • Monitoring coding and billing compliance
  • Preparing and transferring claims
  • Keeping track of payer’s fulfillment of their financial responsibility
  • Deriving patient bills and statement
  • Arranging collection of the payments

Why is Medical Billing Important?

At the first glance, medical billing may seem exhausting and time-consuming, but it has many benefits that outweigh the costs. The best way to reap the benefits of medical billing without the headache of hiring or training staff to manage it in-house is to outsource it to a medical billing company. With this one task lifted off your shoulders, you may focus more on patient care and quality of service.

External medical billing leads to a reduced administrative burden on the staff. Since you are outsourcing your billing practice to a company that already has extensive experience and expertise in the field, you are more likely to reduce billing errors, enhance cash flow, and improve billing compliance. Furthermore, more secure patient data would ensure patient satisfaction and prevent denials and delays in claim reimbursements.

What is CGM?

Short for a continuous glucose monitor, CGM is a professional glucose monitoring system. This device detects trends and traces patterns in people 18 or older with either type of diabetes mellitus (DM). The CGM system requires a prescription and exists solely for the use of healthcare professionals. The readings from a CGM are only available to the healthcare practitioner who then analyzes them to give a consultation report to the patient.

The CGM helps in the detection of increased or decreased glucose levels outside of the normal range. Your doctor analyzes the trends and patterns over a specific period and makes appropriate adjustments to your treatment plan.

cpt code 95251

Billing for CGM or Continuous Glucose Monitor

CPT codes for continuous glucose monitor include the CPT code 95249, 95250, and 95251.

CPT Code 95249: Ambulatory continuous glucose monitoring (CGM) of interstitial tissue fluid for a minimum of 72 hours via a subcutaneous sensor. Used to code for patient-provided equipment, hook-up, sensor placement, calibration of monitor, patient training, and printout of recording.

CPT Code 95250 – Ambulatory continuous glucose monitoring (CGM) of interstitial tissue fluid for a minimum of 72 hours via a subcutaneous sensor. Used to code for physician or other qualified health care professional (office) provided equipment, hook-up, sensor placement, calibration of monitor, patient training, removal of the sensor, and printout of recording.

CPT Code 95251: Ambulatory continuous glucose monitoring (CGM) of interstitial tissue fluid for a minimum of 72 hours via a subcutaneous sensor. Used to code for analysis, interpretation, and report of glucose monitoring.

CPT Codes 95249 and CPT Code 95250 are used for the technical component of continuing glucose monitoring. It covers glucose sensor placement, patient training, monitor calibration, use of a transmitter, removal of the sensor, and downloading of data.

Limitations for CPT Codes 95250 and 95251

  • Minimum Reporting Time

CPT Code 95250 and CPT Code 95251 have a minimum sensor time of 72 hours. Neither of the two codes can be billed if continuous glucose monitoring (CGM) is provided for less than 72 hours.

  • Reporting Frequency

CPT Code 95250 and CPT Code 95251 are limited to one report per month per patient. This is regardless of the period of professional continuous glucose monitoring (CGM). The patient could be provided CGM as many times during a month but it is always reported once during CPT coding for glucose.

ICD-10 Diagnosis Codes to Go With CPT Codes for Glucose

Here is a list of common ICD-10 diagnosis codes, which are used simultaneously with the above-mentioned CPT codes for glucose.

  • 649 Type 1 diabetes mellitus (DM) with hypoglycemia, without coma
  • 65 Type 1 diabetes mellitus (DM) with hyperglycemia
  • 69 Type 1 diabetes mellitus (DM) with any other specified complication
  • 8 Type 1 diabetes mellitus (DM) with any unspecified complications
  • 9 Type 1 diabetes mellitus (DM) without complications
  • 00 Type 2 diabetes mellitus with hyperosmolarity without non-ketonic hyperglycemic-hyperosmolar coma or NKHHC
  • 649 Type 2 diabetes mellitus (DM) with hypoglycemia, without coma
  • 65 Type 2 diabetes mellitus (DM) with hyperglycemia
  • 69 Type 2 diabetes mellitus (DM) with other specified complications
  • 8 Type 2 diabetes mellitus (DM) with unspecified complications
  • 9 Type 2 diabetes mellitus (DM) without complications
  • 00 Other specified diabetes mellitus with hyperosmolarity without non-ketonic hyperglycemic-hyperosmolar coma or NKHHC
  • 01 Other specified diabetes mellitus with hyperosmolarity with coma
  • 49 Other specified diabetes mellitus with other diabetic neurological complications
  • 65 Other specified diabetes mellitus with hyperglycemia
  • 8 Other diabetes mellitus (DM) with unspecified complications
  • 9 Other specified diabetes mellitus (DM) without complication

95251 cpt code

Who is allowed to Perform and Bill CPT Code 95250?

As mentioned above, the CPT code for glucose is used to bill for all the actions that enable monitoring glucose levels. These include setting up the sensor, hooking it up, calibrating the monitor, training the patient during CGM, removing the sensor, and getting a printout for the recorded results. These services coded for may be performed by:

  • Certified Diabetes Educators (CDE)
  • Laboratory Technicians
  • Medical Assistants (MAs)
  • Nurse Practitioners
  • Physician Assistants
  • Physicians
  • Registered and Licensed Practical Nurses
  • Registered Dieticians (RDs)

Any licensed healthcare professional qualifies as someone who can perform and bill CPT code 95250. Hospital outpatient departments are usually required to bill this CPT code for glucose on a standard UB-04 claim form for the respective institutions.

Who is allowed to Perform and Bill CPT Code 95251?

The CPT Code 95251 for glucose is used to bill for the analysis, interpretation, and reporting of continuous glucose monitoring (CGM). These are accurately documented in the patient’s charts to later print professional CGM reports for the patient’s medical record. The following may bill under this code:

  • Physicians
  • Advanced practice healthcare practitioners (HCPs), such as nurse practitioners (NP) and physician assistants (PAs)

While CPT Code 95250 can be billed by almost any of the registered and certified staff at a healthcare facility, the billing of CPT code 95251 is quite limited. The payer and state laws vary in each state and some may not restrict billing of this code by even a registered dietician.

See Also: The Value Of Remote Patient Monitoring Medical Billing

Conclusion

With the CPT codes for glucose right at your disposal and Precision Hub as your trustee, learn to optimize your workflow with office management and claims management processes. We enable you to deliver patient-centered care and leave no stones unturned in making your healthcare facility stand out in efficiency amongst its competitors.

Whether you need consulting services or finance and accounting solutions, we are here to help you streamline your administrative processes and optimize your revenue management cycle. Contact us today and choose from our wide range of data-driven services!

The Importance Of Provider Credentials In Medical Billing: What You Need To Know

credentials in medical billing

Identifying and verifying providers’ qualifications is an important part of the credentialing vs. contracting process. In some cases, payers check for credentials in medical billing, such as certification or licenses, and may also require professional liability insurance. Each payer will have different standards.

Whether a provider meets these standards is not a simple decision, and the process can be time-consuming. Identifying providers with the right credentials can help reduce administrative costs and streamline the contracting process.

Time-consuming Process

When you’re a healthcare provider, the credentialing and contracting process can be time-consuming and frustrating. In many cases, the process takes months and you cannot bill your services until the contract is effective. It is also necessary to keep all relevant paperwork and respond quickly to requests for new information. The healthcare industry has many regulations, so credentialing can be a major bottleneck.

To obtain the necessary accreditations for your practice, it is important to be in contact with the insurance companies that cover your patients. This process, also known as contracting, entails negotiation with insurance payers and the healthcare facility. It is important to understand the contract and the obligations it contains. Different payers have different contracting requirements and require different types of information from providers. Therefore, it is essential to get professional guidance.

Upon becoming a participating provider, the insurance company will contact the insurer’s credentialing and contracting departments to confirm that they are qualified to practice medicine. The credentialing process is lengthy, taking 90 to 120 days. However, by planning ahead, the process can be accelerated significantly. Some practices begin the credentialing process as soon as they hire a new physician. This way, they can meet the deadlines of the insurers and ensure they get the necessary credentials in medical billing.

Mistakes to Avoid

Regardless of the nature of your practice, provider credentialing and contracting are important aspects of running a successful medical practice. Acquiring insurance company contracts and patient referrals is vital to maintaining a healthy cash flow. But the process can be complex and prone to errors. Avoid these common mistakes to ensure a smooth and timely credentialing process.

First, make sure that the documents submitted by the provider are accurate and match the information provided in the application. Inaccuracies, changes in practice ownership, and professional references can all cause problems. Make sure to cross-check the provider’s references before submitting them. Secondly, do not let the application process take longer than it needs to. It is better to submit the application and receive payment sooner rather than later.

The next mistake to avoid is overspending on the process. Depending on your practice, you can tailor the credentialing process to meet your practice’s specific needs. Be sure to include all relevant information for every provider. Providing a complete list of all available information will help you expedite the process. Keeping everything up to date will also save you time and money in the long run.

Third, it is important to have the right tools and procedures in place to streamline the whole process. Credentialing is complex, with many stakeholders involved. Having the right tools and technologies will help you streamline it and ensure that everything goes smoothly. If any details are missing or incomplete, it could lead to significant delays and compensation fees.

Cost-savings

Managing the costs of provider credentialing and contracting can be difficult. It is necessary to follow stringent guidelines for contracting and credentialing, but the benefits of these processes far outweigh the expenses. Using an online provider database can eliminate duplication and ensure accuracy throughout the credentialing process.

The initial setup and management of a database can run between $200 and $500, depending on the provider, the size of the practice, and the frequency of database changes. The cost of managing a database can range from $50 to $100 per month. It may also cost you around $100 per insurance panel to complete the application process. However, this cost can be doubled or tripled if multiple providers are involved.

When you integrate your provider contracting vs. credentialing processes, you can streamline the process and eliminate redundant efforts. By ensuring data security, this process will accelerate onboarding and cut down on administrative costs. It is also critical to maintaining a consistent data set for patient safety.

The fact that provider data comes from multiple sources and is stored in different systems means that there is no one single source for this information. The lack of communication leads to multiple requests for the same information and, as a result, delays in credentialing and contracting processes.

Primary Source Verification

To protect patients and minimize the risk of negligent healthcare credentials in medical billing, hospitals and healthcare organizations must utilize primary source verification. This process ensures that health professionals have appropriate credentials in medical billing and are not practicing medicine without a valid license.

While many secondary sources are unreliable and biased, primary source verification provides a more accurate picture of a provider’s training, experience, and current competence.

Primary source verification is successfully done using a variety of methods. Primary source verification may be obtained through written, telephone, or website submissions. In writing, primary source verification can be a letter, fax, e-mail, or paper report.

Verifying provider credentials in medical billing at the primary source is important for patient safety and prevents malpractice lawsuits. However, primary source verification is a time-consuming process that can be overwhelming, costly, and resource-intensive. Healthcare organizations can reduce this burden by outsourcing the process to a Credentials Verification Organization (CVO). The services offered by a CVO are reliable, automated, and can help organizations minimize risks and avoid non-compliance.

credentialing vs contracting

Common Healthcare Professions

The process of credentialing a healthcare provider often involves processing a large amount of data and can take anywhere from three to five months. Furthermore, multiple stakeholders must be considered. If any detail is overlooked, it can lead to significant delays and compensation fees. This is why it’s important to choose a credentialing solution that can speed up the process and ensure a successful outcome.

One of the most critical aspects of healthcare credentialing is the quality of information. Credentialing professionals are responsible for reviewing the entire provider data file to ensure that the information provided is accurate. This process involves assessing each provider’s education, training, experience, history, and licensing to ensure that it is accurate. Although credentialing professionals rarely make decisions on their own, they can provide key insight to the credentialing committees.

Another aspect of credentialing is the accuracy of the data entry process. It’s not enough to fill out application forms. Credentialing processes may require supporting documents as well. If these documents aren’t properly entered, the process may result in incorrect information, causing insurers to reject a provider’s claim. This is where automation comes in handy. Automation can avoid many mistakes in the data entry process.

Tips for Successful Credentials in Medical Billing

The credentialing process is a cumbersome process that can delay cash flow, cause scheduling issues, and cause repeated phone calls from payers. This process involves background checks of the provider, including social media, financial, and criminal history.

Because of the multiple steps involved, it can take longer than expected. The best way to ensure a smooth process is to prepare early. If you are unable to complete all the necessary steps on your own, consider hiring a credentialing coordinator. This person will help you track deadlines and send timely reminders.

Be meticulous with your documentation. It’s important to submit accurate reports and follow up with insurance companies to ensure proper reimbursement. Make sure to carefully review your application and follow up regularly with questions. This will reduce the rate of denials. Having a solid team to oversee the credentialing process is critical, and the right timing is crucial to its success.

Make use of healthcare credentialing services. They’ll help you capture revenue and see more patients quickly. With these services, you can focus on providing the best patient care. Whether you need credentialing services for your facility or are looking to expand your business, they can help. Having a partner in this process can give you the peace of mind that comes from knowing you’re not on your own.

See Also: Edi In Medical Billing – The Complete Guide

Conclusion

If you are a medical provider, credentialing and contracting are essential to your success. Without this process, you risk not being credentialed in medical billing and a lack of trust from patients. In addition, many patients will refuse to see a provider who is not in a healthcare insurer’s network. Therefore, this process will help you establish yourself as a respected medical provider and save you money in the long run.

Make the credentialing process easier for your physicians with our cost-effective solutions. Precision Hub offers highly efficient credentialing and enrolment services for medical practices and healthcare providers. To know the complete list of services we offer, contact a Precision Hub Manager or check out our service page.

Is Outsourcing Medical Billing A Good Idea? 7 Reasons To Outsource Medical Billing

outsourced medical billing

Outsourcing medical billing may seem like a great idea. But, if you don’t know the benefits and drawbacks of this option, you’ll be left scratching your head and wondering: is medical billing really worth the cost?

If your in-house staff is struggling to keep up with patient billing, it may be time to outsource medical billing. The right company can help you avoid turnover by handling the bulk of the billing work and saving you time and money. Additionally, hiring an expert outsourced medical billing company can reduce employee burnout and keep your focus on caring for patients.

In this article, we’ll outline the benefits of outsourcing medical billing, and what you can do to avoid hiring an inefficient or inexperienced biller.

Benefits of Outsourcing Medical Billing

  1. Reduced Administrative Duties

One of the main benefits of outsourcing your medical billing department is that the company will handle the ins and outs of the entire process. Outsourced companies can keep up with the latest trends in medical billing while reducing your staff overhead.

By using an outsourced billing company, you’ll free up valuable resources to focus on patient care, staff training, and staying on top of new technologies. Outsourcing medical billing services can increase your cash flow and reduce your expenses at the same time.

  1. Reduced Billing Errors

The process of billing for a medical practice is tedious, time-consuming, and often requires lengthy recoding and error-checking. Outsourcing your medical billing will relieve your staff of these tasks and increase the likelihood of reimbursement from insurance companies.

In-house teams often lack the time to thoroughly process bills, which can lead to costly mistakes that can affect your revenue streams for years. By hiring an experienced company, you’ll be assured that their medical billing team will handle the process with utmost care.

  1. Improved Cash Flows

Outsourcing your medical billing can also help you increase your revenue and free up your staff to focus on patients. Denied claims cost healthcare providers hundreds of thousands of dollars each year, which can be a significant amount of money.

By leveraging outsourced medical billing services, you can reduce these costs by ensuring quality denial management, which stops denials in their tracks and improves your reimbursement rate. Outsourcing medical billing can also mitigate revenue slumps. Medical billing mistakes can result in delayed payments, claims denials, duplicate billing, and excessive disbursements.

  1. Billing Compliance

A company that outsources its medical billing will be aware of changes in regulations. In-house staff is often not up to date on changes in regulations. A third-party company will be on top of any changes in regulations, which will free up a company’s time to focus on other operational areas. The bottom line will benefit.

  1. Better-quality Patient Care

Medical billing outsourcing can also free up your staff to focus on patient care. The billing process can become a nightmare, involving multiple departments. Outsourcing medical billing allows your staff to focus on providing better patient care. It can improve patient retention and satisfaction by eliminating the headaches associated with in-house billing.

  1. Financial Stability

Medical billing outsourcing allows healthcare organizations to optimize cost and profit. Outsourced medical billers will ensure accuracy by applying quality assurance measures. The outsourced medical billing and collection services also maintain competitiveness by staying up to date. They can also certify clean claims. Ultimately, this means more money for healthcare providers. Outsourcing medical billing can be the key to achieving financial stability in your practice.

  1. Secure Patient Data

Many medical billing outsourcing providers use HIPPA-compliant tools and platforms. As such, they can deal with sensitive patient and service information. Because they have stable, secure billing processes, they can confidently store patient information.

outsourced medical billing

Costs of Outsourcing Medical Billing

Medical billing outsourcing offers many benefits. However, it can also pose some challenges, especially for smaller medical practices. Outsourcing medical billing can leave administrative control in the hands of an external company. In addition, conflicting software can make the process less transparent.

Some billing services only pick high-value accounts, making it more difficult for medical administrations to keep track of payments. Furthermore, some patients may not feel comfortable with an external agent processing their account information.

Cost of Hiring an Inexperienced or Inefficient Medical Biller

A large portion of the revenue cycle is lost to mistakes made by inexperienced or inefficient medical billers. These mistakes can include incorrect coding, ineffective collection policies, and errors in patient registration, insurance verification, and claims documentation. These mistakes lead to delayed payments and denied claims.

Hiring an inexperienced or inefficient medical biller will prolong the revenue cycle and increase operational costs. A better solution to this problem is to outsource your billing to a medical billing company.

Hiring a medical billing team is a time-consuming task, and it can be difficult to hire and retain the right people. It is often difficult to tell if a prospective hire has the right experience and skill level for the job before making the first payment. A reliable medical billing service will keep track of changes in coding and ensure that all claims are correctly coded and submitted.

Importance of Introspection before Outsourcing Medical Billing

Whether you’re a small group, a solo practitioner, or a large practice, the importance of introspection before you outsource medical billing services should not be underestimated. Outsourcing services will help you meet the needs of patients and your business, but you should not allow this to be an excuse for not keeping your own records. Your medical practice is a business, and as such, you’ll want to ensure that any third party you work with adheres to strict privacy and security standards.

While in-house employees are often the driving force behind a medical practice’s success, these individuals do not always have the time or energy to keep up with changes in the industry. Medical billing is one area that is constantly changing. Outsourcing can improve your cash flow and reduce errors.

Nevertheless, it’s important to take the time to evaluate the goals of your medical practice and the goals of your billing service provider. For instance, front-desk staff may interact with patients more than other members of the practice’s staff. While back-office decisions are transferred to the billing company, front-desk staff needs to prioritize patient interests.

Outsourced medical billing companies can handle your administrative duties in just 30-60 days. Make sure to check with them about ongoing training and the type of billing software they use. Finally, consider how much the medical billing company will charge for each service. This will depend on the size of your practice and the number of providers.

Outsourcing your medical billing is cheaper than hiring in-house staff. You’ll save on staff salaries, benefits, training, and management. In addition, medical billing companies bill faster than in-house staff, resulting in higher net collections and more reimbursements.

Moreover, the cost of outsourcing is low and the ROI is high. In addition to these benefits, they also use specialized billers who know insurance policies well. You can have more time to engage with your patients and manage your business.

See Also: Edi In Medical Billing – The Complete Guide

Conclusion

Outsourcing your medical billing is a great idea for many reasons. Outsourcing eliminates many of the hassles and headaches of managing your practice’s revenue management cycle.

Medical billing service providers are committed to billing and are aware of new regulations. Outsourcing also offers greater transparency and control, allowing you to monitor the entire process and ensure you’re getting accurate billing.

The advantages of medical billing outsourcing are many and they can be beneficial for any type of practice. You’ll be glad you made the move. And there’s no need to worry about training your staff. Precision Hub is a full-stack medical billing company offering HIPPA-compliant medical billing and coding services to hospitals, clinics, and consultants.

We offer complete medical billing solutions and fully-automated coding services to private medical practices and practitioners. Get in touch to outsource medical billing.