South Florida’s Cutting Edge Healthcare Consulting Agency

What Is Billing Optimization?


Call Us

(954) 461-8583

Contact Form

billing optimization

Improving the revenue cycle through billing optimization is an essential goal in the healthcare industry. As a result, the importance of revenue cycle management continues to ring true that cash flow fuels the practice. Therefore, efficiency is integral in saving money and enhancing reimbursement times. Furthermore, revenue cycle managers must continually monitor and review best practices. 

Utilizing electronic reporting through the current EHR program can pinpoint problems, leading to corrections. However, EHR companies need to train their revenue cycle managers to use the software for this to occur. Therefore, if you do not understand how to manipulate the software, you can’t find the problems. Finally, once the root causes of issues are identified, lost revenue can be corrected, and gains can be strengthened. 

An Overview of Billing Optimization 

Billing optimization is the review of daily processes and investigation through audits ensuring all revenue cycle processes work efficiently to produce the best cash flow. First, analyzing approaches to recommend best billing practices tracks denial rates, error rates, days in accounts receivable, and debt accumulation. Secondly, monitoring coding errors by finding the top code denials and errors can clear up coding mistakes. 

Finally, focusing on primary processes can improve revenue collection by 10%. Using software dashboards daily can improve awareness and accountability for billing entities and revenue management. In addition, utilizing the data on the dashboard for a daily tweak can be an effective billing optimization tool. First, however, you must understand dashboard numbers and their effects can eliminate more significant problems in the long run. Finally, a review of monthly statistics will ensure all components are meeting goals.

What Are the Benefits of Billing Optimization?

The billing department processes will reap the highest percentage possible for cash flow benefits the practice. Therefore, they must be given the tools and training for billing optimization. However, recognizing denial holds and errors can produce clean claim submissions for faster reimbursements. Finally, joint efforts with management and billing can make consistency and transparency in operations the most valuable measures. 

Once problems are identified, they must be acted upon immediately. For example, billing optimization methods by running analytics are successful, but moving forward to correct the processes is crucial. Likewise, credentialing, coding, or training problems can be significant rejection or denial reasons. Additionally, a collections department must address problems with patients needing to pay the patient’s responsibility. Consequently, offering incentives for self-pay patients, having a clear collections protocol, and making the patient portal accessible for quick pay are all positive resolutions to slow patient collections

Billing Optimizing And Improving Revenue

Tracking accounts receivable days is one technique that can help realize billing optimization guidelines, whether insurance rejections, denials, or lack of patient payments. But, first, determine the days in AR for each insurance company to establish predictable procedures. Secondly, establish accountability with one person for denials in the follow-up claims.

Finally, determine all other holds on cash flow factors and make a plan to resolve problems. The following tips can help you with problems when running analytics and learning how to use billing optimization to improve cash flow for your healthcare practice or facility. 

Common Billing Optimizing Techniques To Improve Revenue

Accurate Medical Coding: for your billing optimization audit to produce the changes in cash flow you want, utilizing the knowledge of a certified coder is paramount to cut errors. For example, an experienced certified coder with the provider specialty can cut denials, errors, and rejections and increase cash flow. In addition, a certified medical coder understands how to receive the highest reimbursement percentage for each claim submitted. Finally, incorporating the following techniques will help to achieve a higher collection rate.

  • Hire a certified medical coder to check all codes, diagnoses, and charges on claims. 
  • Teach the providers of services to stay away from non-specified diagnosis codes. 
  • In addition, be sure the certified coder is aware of correct modifier usage per Medicare and payer-specific guidelines for all pertinent payers.
  • Do not allow the practice of up-coding and under-coding.
  • Monitor charge reconciliation regularly.

Submission of Clean Claims: the resubmission of claims costs money. In addition, resubmission costs more if resubmitted more than once. The industry average for clean claims is 79 to 85% per First Pass Acceptance. However, they state that any percentage over 90% is acceptable. Check your software’s dashboard and healthcare clearinghouse’s dashboard once claims are transferred over for your statistics. Your goals should be over 97% for excellent billing optimization.

Make Payer Correspondence a Priority: More and more insurance companies are requesting medical records, authorization numbers, and insurance eligibility information from the patient. However, these demand additional time to the days in AR and could be better if someone returned correspondences within 24 hours. In addition, critical and time-intensive requests must be flagged as a process. Finally, all mail with returns must be scanned and documented for proof. 

More Billing Optimizing Techniques To Improve Revenue

In addition to the above examples of billing optimization techniques to improve revenues, there are more below.

Payer Contract Negotiations and Enforcement: The electronic healthcare software system should be directed to implement a report to ensure reimbursements align with contracted reimbursements. However, managing this aspect of the revenue cycle is an administrative task. Medical billing personnel collect charges, submit clean claims, and post payments. In addition, the administration is responsible for payer negotiations to ensure their providers receive adequate service payments. Finally, this process could improve collections by 20 to 25%. 

Maintain an Effective Denial Management Team: A key factor for your medical billing department is setting an effective denial management and billing optimization protocol. For example, denials add days to AR and can cause considerable losses in revenue if not worked properly. Above all, denials must be completed within 48 hours of receipt. Finally, the certified coder must review coding discrepancies and log them for the team to intercept should they become a pattern. 

Explore the Possibilities of Billing Optimization Techniques in Florida

When providers are concerned about their collection rate and management turns to the billing department for answers, Bloom Healthcare Consulting in South Florida can assist in billing optimization. Providing professional assistance for those within the healthcare industry, Bloom can analyze your practice or facility through audits to find where problems may exist. In addition, there are other services we specialize in that could help to save your business revenue.

Contact us through our contact form on our portal now.