Billing efficiency plays a crucial role in maintaining the financial health of any business. With increasing downgrades, hospitals need to code at the same angle. Being aware of trends and how to stop them can help your organization improve billing performance. By understanding key metrics and refining your processes, you can ensure accurate, timely billing while maximizing revenue opportunities.
Many hospitals fall below the billing distribution national average for 99285 claims, leaving significant revenue untapped. To address this, hospitals must focus on optimizing their charge capture processes and consulting with experts. Here’s how:
1. Tighten Billing Guidelines
If you aren’t optimizing your billing guidelines correctly, you’re likely missing out on revenue. Regularly auditing your coding practices can also help identify any discrepancies and prevent revenue leakage. Ensuring your guidelines align with payer standards and national benchmarks is critical to capturing the full value of the care you provide.
2. Ensure Billers Follow Processes
Even if your billing guidelines are optimized, your billers may not be following them as intended. Regularly reviewing your adherence to these processes, and training your team to follow them, is essential. This ensures no services are missed or underbilled due to inconsistent processes and helps capture forgotten procedures like follow-up visits, lab tests, or minor surgeries that might otherwise go unbilled.
3. Maximize Charges Through Charge Capture
To be successful, hospitals need a robust charge capture process. Consulting with an expert can help you review claims, medical records, and billing practices to uncover missed opportunities. This ensures you aren’t missing out on revenue, you remain complaint with regulations and you can improve your approach for handling reimbursements. For example, not all hospitals bill for critical care, but if your hospital qualifies, it’s essential to ensure you’re billing for it in every applicable case.
By focusing on these areas, hospitals can improve their billing practices in comparison with national benchmarks, recover lost revenue, and ensure they are appropriately reimbursed for the care they provide. Even if you think your processes are fine, a thorough review can uncover hidden issues and opportunities for increased revenue.
