Medical billing, medical plan billing, or electronic billing, as it is also known, is one of the most important components in the success of any individual or group Medical Billing Practices. From an administrative point of view, it is definitely the most important. The continuity of said operation depends on it.
Despite its importance, on many occasions it is not given the necessary attention, care and supervision so that the efficiency in the operation of the medical office is not affected. The relationship between an efficient medical billing and a profitability that goes according to the volume of patients that are attended, is a directly proportional relationship, without considering the control of expenses, which is also an integral part of the equation.
The profitability of the practice is affected when denials and / or recoveries are received from insurance companies or medical plans, as they are also known. In the vast majority of cases, these denials and / or recoveries are the result of errors in medical billing.
The most common errors in medical billing are duplication of bills, errors in patient eligibility, procedures that do not correspond to the submitted codes, codes not covered, invalid codes, incorrect or not applicable modifiers, not updated or incorrect rates, lack of relevant clinical documentation, lack of referrals and / or authorizations, among others. All these errors result in the denial of recoveries from insurance companies, which negatively impacts, and in some cases dramatically, the cash flow of the medical practice. In these cases, a medical audit could be very beneficial in identifying the cause and magnitude of these errors.
To the extent that these errors are controlled and minimized, the certainty of the income projections of the medical office will be more reliable. Having accurate financial information will result in increasing the value of the medical practice and being able to maximize the use of resources, which will definitely significantly and positively impact the profitability of the medical practice.