Medical Billing Process

The Medical Billing Process is comprised of numerous financial complexities that can make or break the cash flow management and balance billing for claims reimbursement of a medical practice in the medical billing claim process.

Whether it be processing medical claims or understanding balance billing, incident to billing for physician assistants, or incorrect application of benefits, the medical billing specialists at Medical Bill Gurus are ready to make your practice more profitable.

Physician Advocacy:

With the physician advocacy platform, Medical Bill Gurus is ready to look at the billing structure and revenue cycle management in place, and identify potentials revenue streams such as wrongful application of HMO rates instead of lesser discounted PPO rates and auditing of non-compliant managed care discounts, physician assistant (PA) billing and reimbursement, and claims denial management solutions to develop a revenue recovery plan.

Using key performance indicators (KPI’s) in medical billing processes, Medical Bill Gurus provides medical billing and revenue management strategy on how medical providers should be looking at medical billing data such as medical billing revenue, medical billing profit, number of claims submitted, number of claims denied, etc., and identifying relationships based on defined key performance indicators (KPI’s) to determine a “practice rating”.

A key performance indicator (KPI) is a measurable value in medical billing that demonstrates how effectively a business is achieving a key business objective, such as metrics commonly discussed in the medical billing and coding process, and the medical bill invoicing process that dictates revenue cycle billing.

A practice rating helps management make strategic business decisions based on key performance indicators (KPI’s) and where to allocate resources to help maximize the amount of medical billing revenue being captured and minimize overhead costs, as well as lost medical billing profits in the form of short-payments and incorrect applications of benefits.

Key Performance Indicators:

Let’s define some example key performance indicators (KPI’s) that a medical practice could use to make strategic business decisions regarding the medical billing process and claims denial management, and evaluate a sample strategy from the Medical Bill Gurus offensive playbook on medical billing revenue recovery.

First, identify the number of medical billing claims “n”, denied medical billing claims “D”, and medical billing claims paid out “P” by the insurance company. You can do this during evaluation period or create a routing reporting template that management and medical billing staff can use to assess key performance indicators (KPI’s). Based on these calculations, we can make the following characterizations of how the current claims denial management strategy is performing with respect to the medical billing process.

Uncaptured Medical Billing Revenue:

Now that we have identified key performance indicators (KPI’s), we need to perform a root cause analysis (RCA) to determine what actions or changes can be implemented to correct denials and uncaptured medical billing revenue in the medical billing process.

A root cause analysis (RCA) is a structured facilitated team process to identify root causes of an event that resulted in an undesired outcome and develop corrective actions, such as the auditing of contractual underpayment and managed care contracts.

The root causes analysis (RCA) process enables your medical practice to define strategy to identify friction points in medical billing processes and systems that contributed to the negative outcome, and how to minimize the occurrence of future negative outcomes.

A root cause analysis one of the most important staff interactions a business can take part in, as it will help define your strategy on all levels of your organization, from the medical billing staff, the medical staff, and the overall organization.

Given our example medical billing strategy for claims denial management, let’s evaluate some of the friction points and issues that could impact your organization’s paid claims ratio “PC” and denied claims ratio “DC”.

Root Cause Analysis:

Performing a root cause analysis (RCA) will help Medical Bill Gurus and your organization to determine the foremost reason for denial of the claim by the insurance company, and identify corrective action(s) that can be taken to increase the paid claims ratio “PC” and lower the denied claims ratio “DC”.

Corrective action “CA” is defined an action or strategy to address a root cause and eliminate the root cause to prevent reoccurrences of the negative outcomes in the medical billing process.

Corrective actions are only temporary until a permanent solution is put in place, known as a preventative action “PA”.

Preventative actions “PA” are geared towards looking at the overall medical billing strategy, and dedicating medical billing and coding resources to address the issues head on, and prevent them impacting any key performance indicators (KPI’s) that dictate the overall outcome for medical billing revenue, lost profits, and overall cash flow cycle.

Given that claims denial management is directly correlated to medical billing revenue and profit, it is vital for medical organizations to consider medical billing professional such as the medical billing specialists at Medical Bill Gurus to improve the bottom line with processing medical claims, and provide medical billing expertise to track and analyze trends in payer denials and rejections.

Developing corrective and protective actions for medical practices, Medical Bill Gurus can provide medical bill auditing of closed and aged accounts, physician assistant (PA) billing and reimbursement, and professional medical billing services to act as a supplemental revenue collection policy for your office.

It is the goal of Medical Bill Gurus to raise the level of your staff’s awareness with respect to your commercial insurance accounts, managed care contracts, and relationships, such that your organization can improve contractual terms, rates, and relationships with your contracted payers and managed care networks.

Medical Bill Gurus provides all services for medical providers in all 50 states on a contingency basis, such that there are no hidden fees, expensive consulting costs, steep software to buy, or upfront fees to get started.

All insurance payments are paid directly to clients, such that Medical Bill Gurus acts as third party, and simply invoices a service fee on the profits recovered for your organization.

Our comprehensive services are designed to maximize your profit while minimizing your costs. Let us take the stress out of your billing cycle.

To learn more and receive an instant quote, please call our physician advocacy representative at 1-800-674-7836.