The medical billing team is responsible for preparing medical claims and submitting it to payers and insurance companies to receive reimbursements. The basic job of a medical billing team is coding and preparing payment claims and making medical billing services fees on behalf of a healthcare services provider.
Medical billing and coding supervisor at Sybrid MD emphasizes the fact that the billing team is the backbone of healthcare services providers as it ensures consistent collections and coordinates with all other teams to keep the business viable.
However, if the healthcare managers lack the training and skills to manage different silos in an organization it can result in declining profits and missed revenue targets.
Understanding the workflow of a medical billing team
Medical billing is the process by which an invoice is created and issued following a medical service or procedure performed. For this process to be effective, all relevant steps must be carried out effectively. The above activity is recorded in a billing format which constitutes the main information related to the insurer and service providers. Through this document, the patient who received services is identified and the services are described in ICD and CPT codes.
The increase in the costs of medical services has forced insurers to control the issuance of payments to service providers. Each insurer has established requirements to facilitate and expedite the payment of claims to ensure that providers are rightly paid.
These diverse requirements make medical billing complex, therefore, the medical billing team must have the appropriate knowledge and skills to perform these functions. There is no doubt that the growth and financial stability of the providers depend to a large extent, on the efficiency of the team handling billing.
Embracing digital healthcare
The electronic claims process is much simpler and faster compared to the manual paper billing process. Most of the larger insurance payers offer electronic claim filing. You can choose between direct billing or set up an account with a clearinghouse.
A clearinghouse is a company that will accept all of your claims and electronically forwards them to insurance payers for processing. They also have edits in place to check for errors on your claim to help avoid billing delays.
The main benefit of electronic billing, whether you use clearinghouse or direct invoice, is that it speeds up the processing of your claims.
The business impact of a medical billing team
The financial challenges of any business are the same. Medical providers need to have a well-controlled cash flow and plan the actions to obtain the best financial results. In the case of large medical facilities such as providers, it is important to be aware of some factors that can impact the business sustainability of the organization.
The routine of a medical facility is intense and needs training professionals to keep up with that rhythm. The challenge is to optimize resources to improve performance.
The first step for billing management is the financial department that coordinates the billing with management and billing resources. This must function at the same pace as the demand for health services.
The billing team has to compile health records, medical reports, medical requests, medical records, and information on surgeries and exams. All this must be well organized for the collection and proof of the medical service provided.
Those routine procedures must be run with well-defined processes. They must also be administered by a management team and audits to ensure transparency and accuracy.
Working with defined processes and is always recommended to healthcare services providers, however, for providers with a high flow of patients it is mandatory to have efficient process management.
The practice that dedicates time to planning day-to-day activities has a huge advantage and reduction of setbacks and delayed tasks. It is essential to record the information with the procedures for the minimum details and situations that may arise in service.
Billing team coordinates with major departments of a healthcare organization
Integrate billing, collections, and accounting can optimize the performance of the billing team. When health managers have unified control, it is easier to manage finances and reduce rejections.
Having information organized in an updated ledger is not enough. The providers must be attentive to performance metrics to have better results every day.
As the providers see more patients, the more important will be to organize the billing department. Review the processes that need to be standardized and managed to generate better results which include: clinical and healthcare, supplies, diagnosis and therapy, financial, internal control, billing, support areas, and information technology.
Lack of standard processes is one of the main villains of billing management. If the billing team fails to confirm an exam, the providers rarely learn of that error. Technology came to revolutionize the way of automating the processes. Integration of EHR, EMR, and Practice Management Tools revolutionized the ways billing and healthcare delivery processes are managed.
Medical billing metrics
The most visible, measurable impact of a good billing team is the reduced refusal rate. Billing professionals have to perform many processes to ensure that denials occur as little as possible. Technology alone will not solve the problems faced by providers and billing departments. A well-prepared team will get more out of the technology only if the processes are integrated and checked for errors. The records of the activities should be easily accessible to the team. Currently, it is possible to measure a large amount of information. But that does not mean that all of them are essential for the management of the billing.
The billing team knows how the insurance plans work and they also know what should be required to get paid from these insurance companies. The billing department knows the rules and regulations and they must have checks to ensure the implementation. The billing team knows if one of the staff members is not credentialed and may cause rejection. The billing team has the information that how good the front office is doing the job. This all information comes in the domain of the billing team just because they have command and the knowledge to maximize the collections.
How billing team has become the center of business
Healthcare providers must give importance to the billing team as they have become the center of business. At one end they must be connected with the care delivery team and on the other end, they must work diligently with the finance department, especially the accounts receivable department.
Because the functions of the accounts receivable department cover the entire cycle that goes from when an invoice is received until it is paid. In general terms, the main functions are Scanning and verification of bills, review, determining their approval, or rejection.
The billing team has come to center stage; however, it must be followed with periodic audits. The billing audit is an organized process that examines and evaluates the effectiveness and reliability of the clinical documentation contained in the health records
It must be well audited by the providers and the medical billing team to ensure that it is accurate and rectified. Improper billing practices can not only lead to business loss but also cause potential compliance issues.
Billing Audits should cover all areas of the medical billing life cycle, starting with the insurance verification processes, claims submission process, payment posting process, tracking processes, and management processes.
Once you identify the fault area it should follow up with proper training to ensure that the mistakes are not repeated. The billing team must be taken seriously to improve the business outcomes of healthcare providers. By focusing on the performance of the billing team, you not only ensure that your staff is working properly but it also guarantees that you won’t miss your revenue targets.