# 1
Medical
Billing Best Practice Number One
Pre-Visit
Screening:
- Why
Eligibility Verification Matters
As a
Medical Biller, your objective in pre-screening insurance eligibility is to determine patient responsibility
before check-in; ideally, before the patient ever leaves their home to
go to their medical appointment. You need to know what's covered
and what's not, preferably before the patient arrives.
# 2 Medical
Billing Best Practice Number Two
Understanding Coverage:
- Benefits
Coverage (for dummies)
Why
does every single insurance carrier report different information and
report it in a different format? Making sense of health insurance
benefits means the difference between getting paid or not getting
paid. Here we seek to unravel the mystery of understanding benefit
eligibility reports.
# 3
Medical
Billing Best Practice Number Three
Check-In
(administrative): - Do's and Don'ts at Check-in / Handling Cash
So
much can go so right, and so much can go so wrong, at check-in. Clear policies and adherence
to those policies are the key to success. In good practices you'll see
many common denominators. Here are a few of them.
# 4
Medical
Billing Best Practice Number Four
Coding Essentials:
- Claim Preparation / Medical Coding / Coding Utilities
Nothing
pays like experience and it is doubly true when you begin preparing
claims for filing. Medical Coding is synonymous with who and what a medical
biller is. Here are a few thoughts from veterans of the craft.
# 5
Medical
Billing Best Practice Number Five
Managing
Claims:
- Filing
Claims Electronically / Scrubbing for Errors
Everything
you never wanted to know about claim transmittal and claim errors!
# 6
Medical
Billing Best Practice Number Six
Working the Revenue Cycle:
- The
Claims Have Been Sent, Now What?
Once
a claim has been sent, it kicks off the revenue cycle and
the sand of time begins running down the hour-glass. Here's the nuts and
bolts of RCM, and how smart billers organize themselves and their
tasks.
# 7
Medical
Billing Best Practice Number Seven
Working the Revenue Cycle
(part
B): - Adjudication,
Follow Up, Re-submittals
Adjudication,
insurance follow-up and avoiding claim resubmittals, could be considered
the necessary core competencies of a Medical Biller. Here's what all
three are about and how to do them.
# 8
Medical
Billing Best Practice Number Eight
Working the Revenue Cycle
(part C): - Payments,
Adjustments, Secondary
Claims
A Medical Biller
needs to enter Payments & Adjustments as soon as payments come in
so that Secondary claims can be filed in a timely manner. It also
provides the practice with current status on patient balances and
insurance balances, which is needed to manage cash flow.
# 9
Medical
Billing Best Practice Number Nine
Denials & Appeals:
- In
a Perfect World
Let's
face it, insurance companies increase their profitability by denying
claims and sometimes they'll deny them out-of-hand for no legitimate
reason just to manage their cash-flow. So if you have a health
benefit payer that insists on a fight, well then let's roll up our
sleeves; here's what to do.
# 10
Medical
Billing Best Practice Number Ten
Collections:
- Patient
Balances : Statements, Payment Arrangements, Collections
As a
Medical Biller your aim is to avoid ever having unpaid
patient balances in your account receivable reports, but in the real world, here's
what to do when you inevitably get them, and expert advise on how to avoid
them.
