Revenue Cycle Management

5 Medical Billing And Collection Tips

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The success of any healthcare facility depends not only on the competency of its providers but also on the efficiency of its organization. If your facility isn’t a well-oiled machine, you won’t be able to support your providers in delivering the best patient outcomes.

One of the most important aspects of an organization that every healthcare facility should prioritize is billing and collection. The operational capacity of any healthcare facility or medical practice, big or small, relies on your ability to effectively generate revenue. It is a business, after all, and no business can survive when profit streams are muddled, confusing, or unpredictable in the revenue cycle.

Luckily, there are several proactive steps you can take to streamline your revenue channels and billing practices. Here are 5 five medical billing tips to shorten your collection times and improve your business.

#1: Learn the Billing Flow From Start to Finish

It’s hard to come up with a solution when you don’t fully understand the problem. When trying to smooth out any kinks in your billing process, your first responsibility is to get a full grasp of how medical billing and collections work.

In general, the medical billing process can be broken down into six parts:

  • Verifying insurance eligibility – Make sure the patient carries health insurance coverage that your facility accepts. Uninsured patients should have reliable financial assistance if needed.
  • Collecting the patient’s portion – Patients are typically responsible for paying some amount of the overall cost for their visit, while the insurance company pays the rest of the medical bill. Make sure the patient is informed about their financial responsibility for patient collections.
  • Sharing procedure and diagnosis codes for each patient visit – In many healthcare facilities, there is a person called a medical coder whose job is to act as a go-between for providers and insurers. For every procedure or diagnosis that the provider undertakes with a patient, there is a corresponding code. This code eventually gets sent to the insurer for reimbursement. First, the provider shares it with the coder.
  • Verifying the proper code selection – Once the coder receives the code, they analyze it to make sure the insurance provider chose the right one. The coder should be knowledgeable in the specifics of procedure coding so that they can add any necessary modifiers to describe the treatment that was given. The practice of accurate medical coding is essential for maximizing revenue.
  • Entering claims into practice management software – Now that the patient’s medical procedures and treatments have been accurately coded, they can be submitted as medical claims to their insurance company via your practice management software.
  • Receiving reimbursement – When the patient’s insurance company receives your claim, they choose to either accept or deny it. If they accept the claim, you will receive a reimbursement, and any remaining balance will be sent back to the patient. If they deny your claim or only partially reimburse you for the medical services rendered, you must address the unpaid medical bills as soon as possible in order to maintain your cash flow.
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#2: Collect From the Patient While They’re In Your Facility

One of the biggest roadblocks standing in the way of a smooth cash flow is the inability to collect from the patient at the time of service. Don’t assume that every patient knows they are responsible for their portion of the cost of their medical care. Some people may not be fully informed about their insurance plan, policy, copays, deductibles, and so on.

Also, don’t take it for granted that every patient knows they can pay their portion at the time of service. If you empower patients to pay on the day of their visit, some patients may opt for this route. This will prevent you and your patients from having to deal with lengthy medical debt collections and paperwork from credit reporting companies.

Your cash flow could be negatively affected if you’re billing patients by mail, following up with them about their bills over the phone, and even trying to recoup their overdue payments through a collections agency. To avoid this, you can:

  • Figure out the patient’s responsibility for medical expenses prior to their visit
  • Consistently keep each individual patient informed about their payment responsibility
  • Take care of services that require pre-authorization in advance
  • Set clear expectations and have price transparency regarding your payment policy
  • Post signs in your facility announcing that payments must be collected upfront

#3: Train Your Staff to Become Experts in Medical Billing

Knowledge, mentorship, and practice are your strongest allies in the fight against lost revenue. Once you get to know your billing process inside and out, you should share that information with your staff and help them develop into billing experts, too.

Much of revenue delays, especially denied claims, are caused by preventable errors in billing procedures. Having a well-trained staff at your front desk ensures that patients’ insurance policies are always verified correctly, proper copays are calculated, and claims are sent to insurers with all of the accurate medical codes.

#4: Focus on the Details When Managing Claims

Insurance claims can be complicated and dense, plus insurance companies are notoriously strict about rejecting claims that have errors. This makes for a situation where you may not receive reimbursement until months after your rendered services, due to a constant cycle of submitting claims, getting denials, editing your claims, and finally resubmitting them correctly. Even a simple spelling error can set you back. See our blog for more information on denial management in healthcare and appealing a denied medical claim.

Paying close attention to the details of each claim can do wonders for your overall patient collections and cash flow. Some of the most common errors on insurance claims include:

  • Incorrect patient information such as name and date of birth
  • Incorrect provider information such as address and contact information
  • Incorrect insurance information such as payor ID and policy number
  • Illegibly written documentation
  • Missing claim number references on appeals of denied claims

#5: Analyze Your Key Performance Indicators

When reviewing their revenue streams and overall financial performance, some healthcare facilities only look at the broadest data points, such as their total payments or the number of denied claims.

However, a proactive and knowledgeable administrative team can do so much more when reviewing their business operations. Analyzing a deeper well of billing key performance indicators (KPIs) will help you generate a more robust revenue management cycle (RCM) that supports steady growth.

Here are a few more advanced billing KPIs that you should consider:

  • Resolve rate – The number of denied claims that you are able to overturn on appeal. This will help you understand if your staff is adequately trained in the claims process.
  • Receivables outstanding over 120 days – The percentage of your total receivables (payments from patients and reimbursements from insurers) that are not paid within 120 days of service. This will help you understand if you are being paid in a timely manner and how well your staff is equipped to follow up on late payments.
  • Average reimbursement per payor – The average amount that each of the insurance companies you work with reimburses you for the same medical service. Analyze your payments for the same procedure code across each payor. If you can prove that one payor pays well below average, you can use that data to help you negotiate a better reimbursement rate with that company on your next contract.

Start Generating More Revenue Today

Medical billing and collection can be tricky to understand, but the time and effort you put in will pay dividends in the future.

While there is a lot you can do on your own to create a more organized and efficient billing process, your overall revenue still largely depends on your payor contracts. Reimbursements from insurance companies are the lifeblood of any healthcare facility. Managing your contracts and negotiating better rates is a must if you want to succeed and grow as a business. That’s where PayrHealth comes in.

Sign Better Contracts with PayrHealth

PayrHealth is the leading payor contract management solution. With over 25 years in business across all 50 states, PayrHealth has successfully negotiated more than 50,000 payor contracts. Signing better contracts helps you maximize your return on investment, expand your team, and focus on delivering the best patient outcomes.

PayrHealth works with all healthcare provider sizes and specialties. In addition to helping you negotiate reimbursement rates, PayrHealth keeps track of your payor contracts and alerts you to any changes that insurers make to the contract language, saving you time and money. Whether you’re looking for new contracts or you want to improve your current ones, PayrHealth can make it happen.

To start generating more revenue, contact us at PayrHealth today.


  1. Imagine Software. 8 Medical Billing Key Performance Indicators and Metrics You Should Be Tracking in 2018.
  2. Business News Daily. Medical Billing and Collection Tips From the Pros.  
  3. HAP USA. 6 Proactive Medical Billing Tips to Maximize Revenue.  
  4. Applied Medical Systems. 5 Medical Billing Tips to Improve Collections.
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