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The Secret of Medical Billing Success

Medical billing services generally boost their clients collection rates by double digits, with some clients seeing revenue increases of 35 percent or more. How do they do it? Tenacious phone solicitation alone wont raise returns by that order of magnitude. The best billing services achieve results by optimizing the entire revenue cycle.

Medical Billing from the Ground Up
"Revenue Cycle Management" has become a catchphrase in the medical billing community--shorthand for a far-reaching overhaul of the entire revenue cycle. Some billing services have expanded their scope beyond claims collection to include billing consulting services. The aim is to bring greater efficiency and accountability to the entire process. The outcome is timely collections, and as such, dramatically increased revenue.

Revenue Cycle Management Services
Third-party medical billing service providers have the experience and technical expertise to manage the revenue cycle from initial patient encounter to collection and beyond (financial planning, budgeting, capital improvements, and so on). The importance of revenue management cannot be underestimated. Tracy Bird, C.P.C., director of consulting services for Kansas Medical Mutual Insurance Company comments, "The revenue cycle is the lifeblood of a medical practice because thats where the money comes from. It should be at the top of every physicians list, right behind good patient care." The cycle, she explains, begins when the patient makes an appointment. An effective revenue collection plan tracks data every step of the way to ensure timely and error-proof claims submission.

Consulting + Technology = Optimized Billing Services
Technology is the cornerstone of an optimized billing service. Todays revenue management applications feature advanced and easy-to use Web-based interfaces to optimize data collection and management at every stage.

  • Before the patients appointment, an automated system helps staff accurately authorize services, determine and validate coverage for payment, assess payment risk, and schedule resources.
  • During the appointment, electronic medical records (EMR) technology enables doctors and other practitioners to record information using a handheld device. That data syncs wirelessly with a central database, ensuring a reliable, real-time record of the encounter.
  • After the appointment, automated medical billing service software pulls the relevant data to prepare accounts receivable claims. The necessary paperwork is typically submitted to the payor--i.e., the insurance company--within 24 hours.

Electronic billing greatly accelerates the current process, which relies on several steps of manual entry and coding. The result is greater accuracy and timeliness, and a dramatic increase in revenue collection rates.

Consultingensures that the practice uses technology effectively. Specifically, the medical billing service implements and manages the electronic applications and provides crucial follow-up. Responsibilities include:

  • Software updates
  • Technical service and support
  • Metrics and revenue reporting
  • Strategic assessment check-ins
  • Negotiation with insurance companies
  • Updates to insurance forms and membership requirements

Revenue cycle management represents the next step in medical billing service. This full service takes a big picture approach to medical billing. Rather than simply collecting on outstanding claims, the service leverages health information technology to bring greater accountability, timeliness, and accuracy to the entire process. Effective revenue management doesnt start with the claim, but with the patient. By developing a reliable process of data collection and management from the outset, ,medical billing services are able to define new standards in revenue collection rates.


Micro MD

American Association of Family Physicians

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