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In this post, we’ll take a deep dive into a critical aspect of revenue cycle management: the billing flow, particularly pre-payment billing.
Billing flow refers to the entire process of generating and submitting medical bills. Security concerns, complex stakeholder agreements, and ever-changing regulations make this a byzantine process that often leaves patients and providers frustrated, short-changed, and stuck in the dark.
This process includes everything from patient registration to coding and billing. It starts before a patient enters the facility and ends long after they’ve received treatment. Because of the number of steps involved, one error in this process can compound down the line, leading to outsized revenue problems that are difficult to identify and root out.
An estimated 80 percent of medical bills contain errors. What’s worse, these billing errors not only impact the speed of reimbursement but also incur additional costs involved in appealing denials. High-dollar claims pose an even greater concern as they often require a more resource-intensive corrective process.
To effectively reduce billing errors, every step of the pre-billing process must be treated as crucial, demanding best practices and attention to detail.
Coordination of Benefits (COB) denials, for example, can be easily avoided by accurately gathering, verifying, and recording patient insurance information. Although seemingly straightforward, these processes become more challenging due to regulatory and economic factors as patients experience changes in insurance coverage. Therefore, maintaining vigilance and precision in COB and other pre-billing procedures is paramount.
Another essential yet often overlooked performance metric is the discharged-not-final-billed (DNFB) ratio, which represents the number of accounts waiting to be billed. Insufficient documentation and coding during care can significantly hinder the completion of patient charts, coding, and abstraction. Therefore, accurately recording the patient's status and place of service is crucial to generating accurate bills and making sure your facility receives every dollar owed.
A great deal of importance is put on achieving high clean claim rates (CCR), with RCM consultants often aiming for rates above 90 percent and clearinghouses promoting percentages exceeding 95 percent. However, it's important to note that while a high CCR indicates claims accepted by payors, it doesn't directly correlate to low denial and underpaid claim rates.
A better metric to focus on is the first pass yield, which represents the percentage of claims that are paid in full upon their initial submission.
Reducing claim denials and maximizing timely and complete reimbursements necessitates pre-billing processes incorporating comprehensive performance monitoring and insights at each stage.
By prioritizing operational efficiency, analytics, and performance monitoring, MEDHOST can assist you in enhancing your revenue cycle management. Contact us at inquiries@medhost.com or call 1.800.383.6278 to learn more.
