In this post, we'll delve into a critical aspect of revenue cycle management: the billing flow, particularly pre-payment billing.

Billing flow encompasses the entire process of generating and submitting medical bills, a complex and often frustrating journey for both patients and providers. Security concerns, intricate stakeholder agreements, and constantly evolving regulations make it a labyrinthine process that can leave all parties feeling short-changed and in the dark.

This intricate process spans from patient registration to coding and billing, commencing before a patient even enters the facility and extending long after they've received treatment. Given the multitude of steps involved, a single error in this process can cascade downstream, resulting in substantial revenue problems that are challenging to detect and rectify.

Why Billing Flow Errors are Costly

An astonishing 80 percent of medical bills contain errors, impacting not only the speed of reimbursement but also incurring additional costs associated with appealing denials. High-dollar claims pose an even greater concern, often necessitating resource-intensive corrective measures.

Pre-Payment Billing Processes

To effectively reduce billing errors, every facet of the pre-billing process demands meticulous attention and adherence to best practices:

Coordination of Benefits (COB)

Coordination of Benefits (COB) denials can be easily avoided by accurately collecting, verifying, and recording patient insurance information. While seemingly straightforward, these procedures become more intricate due to regulatory and economic factors, particularly as patients undergo changes in insurance coverage. Therefore, maintaining vigilance and precision in COB and other pre-billing procedures is paramount.

Discharge Not Final Billed (DNFB) Ratio

Another crucial yet frequently overlooked performance metric is the discharged-not-final-billed (DNFB) ratio, indicating the number of accounts awaiting billing. Insufficient documentation and coding during patient care can significantly impede the completion of patient charts, coding, and abstraction. Hence, precise recording of the patient's status and place of service is vital for generating accurate bills and ensuring your facility receives every owed dollar.

Clean Claim Rate or Real Revenue

While achieving a high clean claim rate (CCR) is often prioritized, with RCM consultants aiming for rates exceeding 90 percent and clearinghouses promoting percentages exceeding 95 percent, it's essential to recognize that a high CCR does not necessarily correlate with low denial and underpaid claim rates. A more meaningful metric to focus on is the first pass yield, representing the percentage of claims paid in full upon initial submission.

MEDTEAM Revenue Cycle Solutions

To minimize claim denials and maximize timely and complete reimbursements, it's imperative to incorporate pre-billing processes that encompass comprehensive performance monitoring and insights at every stage.

Prioritizing operational efficiency, analytics, and performance monitoring, MEDTEAM can assist you in enhancing your revenue cycle management. Contact us at inquiry@medteamsolutions.com or call 1.844.615.1803 to learn more.