Medical Billing Best Practices

Written by: Alex Brown
Published on: Dec 30, 2021

Medical Billing Best Practices

A career in medical billing can be a great way for you to contribute to the healthcare field. The medical billing process is an important function that ensures healthcare providers can “keep the lights on” at their medical facilities.

Ensuring that medical claims are completed, issued, and paid in a timely manner requires a high degree of accuracy. In most cases, installing best practices helps to drive that accuracy, which leads to reduced collection time and increased claim approvals.

Medical Billing Hazards

Issues with billing can lead to stress, frustration, and other negative emotions for patients and providers alike. For instance, failing to enter patient demographic information correctly or not confirming service eligibility can lead to costly denied claims for the provider. Mistakes, omissions, and other issues contribute to delays and time consumed by resubmitting claims. And for the patient, uncertainty around payment coverage can bring anxiety to a household.

So it’s important in your role as a billing and coding specialist that you follow best practices to reduce the risk of errors. Let’s look at some common best practices in medical billing.

Medical Billing Best Practices for 2022

Aim for a Clean Claim Rate Above 95%

A practice’s clean claim rate is the average number of claims paid on the first submission. For most clinical settings, a rate above 95% is desirable. The higher your clean claim rate, the less valuable time you will spend identifying denial reasons and chasing payments. With an estimated 80% of medical bills containing errors, it is critical that you focus on accuracy prior to submission. 

Stay Current on Medical Billing Rules and Regulations

You should constantly be aware of the current medical billing requirements. Healthcare regulations are always changing, so staying informed will contribute to an accurate billing process that minimizes rejections and resubmissions.

Evaluate Your Billing Metrics

You will typically be responsible for meeting certain goals, measured by metrics (or key performance indicators), when it comes to billing. Metrics help to focus staff on meaningful billing outcomes. So you should routinely check in on your billing practices by analyzing billing metrics, including the following:

  • Collections per visit
  • Average days in accounts receivable
  • Net collection rate
  • Total accounts receivable
  • First pass resolution rate (FPRR)
  • Denial rate

If you can keep denials under 5%, total accounts receivable over 120 days under twelve percent, and average days in A/R under 40 days, you will have the office in good shape.

Medical Bills

Review Your Billing Processes

Any process of improvement starts with periodic reviews of current practices. Create a plan to review your billing practices to see if changes need to be made in order to improve metrics. Improvements discovered through this process often lead to reduced billing times, increased cash flow, and improved claim approvals by insurance providers.

Provide a Transparent Fee Structure

According to one study, 67% of Americans are either somewhat or very worried about unexpected medical expenses. While fees and other charges may be easily understood within your medical practice, patients often experience confusion, frustration, and even anger when presented with their medical bills.

One way to avoid this is to ensure your invoices are clearly understood. The good news is that industry expectations have shifted in a way that requires providers to now offer a patient-friendly approach to billing. Transparency helps retain patients and builds a positive reputation for your organization.

Offer Patient-friendly Invoicing & Payment Options

A solid majority of consumers prefer electronic payment methods to pay their medical bills, yet 77% of healthcare providers still send paper bills. Offering a secure patient portal and emailed account statements will meet their needs and align your billing with other service providers, such as utilities.

In addition, digital patient payment options including credit/debit cards, online money vendors, and self-funded plans can help accelerate payments and reduce outstanding A/R accounts.

For more career-related advice from the healthcare industry, bookmark our careers blog.