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3-Key Components of Insurance Billing “Perspective from the Operational Standpoint”


Experts on the Business-Side of health care know that most Doctors do not see medical billing as a holistic team function. The ever changing landscape of medical coding, insurance billing and patient cost share, is cause for doctors to get involved in the health of their revenue cycle. This is why we must open the dialogue and educate doctors and their teams on the 3-Key Components of Insurance Billing

Key #1: Front Office

The front office person or team answers calls, schedules appointments and enters patient demographics and insurance information. Most importantly, they must thoroughly verify eligibility and benefits specific to your specialty. The critical factor at intake is attention to detail as 10 out of the industry’s top 20 insurance denials and rejections are related to intake deficiencies.

Patient Cost-Share! Registration and eligibility issues slow down your revenue cycle; coupled with, the sharp shift in patient responsibility, is crippling your revenue cycle. Insurance companies place more of the cost burden on the patient with higher copay’s, inflated deductibles and coinsurance. It is now the responsibility of the practice to collect money from patients “UP FRONT”.

Key #2: Middle Office

Once the patient steps into your room, the Middle Office begins and depends heavily on your documentation. Your history, Exam and Medical Decision-Making, minor procedure or active treatment/care plan must be complete and signed. Most importantly, your notes must be medically necessary for the level of service selected or for the continuation of said active care plan.

The middle office is also where medical coding takes place. Many coders have identified that template charts in the EMR are both a blessing and a curse! Many doctors and their clinical teams, who do their own coding, are overwhelmed with the daily patient flow. And it is no mystery that this can negatively impact note sufficiency, severity and risk factors being identified; as well as, incomplete and unspecified diagnoses. Which highlights why 7 out of the industry’s top 20 insurance denials and rejections are attributed to the Middle Office.

Key #3: Back Office

The patients have left the building, charts have been signed and closed. As patient flow increases, so does the mis-steps at intake, the incomplete documentation in notes and missed coding corrections. Now, your billing person is left with the aftermath of what can become a vicious cycle of aging rejections, denials and patient responsibility. Insurance companies are tightening the reigns on timely filing, whereas we used to have 1 year to file a corrected claim, now many private payers give up to 120-180 days from the date of service. While Centers for Medicare and Medicaid Services (CMS) set the tone for coding and medical necessity, each private insurance company can tailor their own coding guidelines, which is yet another burden of proof for the billing person.

Current state, solo, small and group practices are better off following the industry trend, by outsourcing their coding, billing, and collections to a trusted partner. Let’s take for instance Platinum System C.R. Our system provides an electronic medical record (EMR) system catered to Chiropractic needs; and from a holistic perspective, we will take the brunt out of your revenue cycle worries and maximize your reimbursements. We have a great team of motivated billing agents and senior medical coders that educate doctors and clinicians on the semantics of documentation integrity, coding, individual insurance requirements and clean claims billing.

In summary, doctors concerned about the health of their reimbursements are welcomed to join Platinum System C.R.’s upcoming webinar where we will take a deeper dive into insurance billing and how to keep your revenue cycle optimized. Prior to joining our webinar where we will have an open forum, doctors should ask themselves these questions related to the 3-Key Components of Insurance Billing.

Front Office

Is my Front Office overwhelmed? And are they properly diagnosing my schedule?

Are they skilled at or comfortable with collecting higher patient costs up front?

Are these front office denials and rejections being communicated by the billing person and resolved?

Middle Office

Is my template set up for proficiency? How can I be sure?

How can I be sure I’ve documented every aspect of patient care every single day?

Would I benefit from ongoing coding education and communication from my billing team?

Back Office

Is my billing person overwhelmed? Can I relieve them of busy work by outsourcing to Platinum Systems Billing Services? Will they focus on more important tasks as prescribed by my outsource partner?

Is outsource billing for me? Did I have or hear about a bad experience in the past? How can I be sure it will work for me?

We welcome you to submit any questions or concerns you may have prior to the webinar. We enjoy the feedback and we believe every question is what others may be thinking or sparks a perspective other may not have otherwise thought of. Hope to speak with you soon.

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