How to Improve Your Reimbursement

improve reimbursement HISIn order to keep your medical practice healthy and thriving, you must collect the full payment that is due to you for the services you provide in a timely manner.  You must have procedures in place to optimize your collections to pay your overhead and keep a staff of competent and contented employees.

Verifying insurance coverage prior to seeing the patient

If a patient’s insurance does not cover the services you provide, there of course will be no reimbursement.  Coverage often changes and it is essential that verification of coverage be done at each patient visit prior to the services being provided.  This will reduce the denial of claims by:

  • Determining eligibility for any services. 
  • Obtaining prior authorization when required. 
  • Verifying services that are covered and determining those that are not covered. 
  • Determining amount, if any, of co-payment, coinsurance or deductibles. 

Upfront collections

It is human nature that patients are less inclined to pay their doctor bill after they have already received the service and left the office than if the fee is collected upfront.  By verifying the insurance coverage and copays, the patients can be informed prior to their visit how much they will be expected to pay out-of-pocket and that the payment will be expected at the time the services are performed.

Outsource your billing

With the ICD-9 Codes being replaced with ICD-10 Codes effective October 1, 2014 many practices are looking for outside assistance in being prepared to keep reimbursements and cash flow steady with the transition to the new 68,000 codes that make up ICD 10-CM code-set.

Many physicians are now outsourcing the management of their revenue cycle (credentialing, coding, billing and collections, etc.) in order to guarantee that the proper codes are being used and claims are being paid upon first submission.  This saves time and money as well as increasing the reimbursement rates.  Healthcare Information Services (HIS) provides many services for physicians, including revenue cycle management (expert medical billing services).  Some benefits of outsourcing this service to a company like HIS include:

  • Use of Certified Coders who are well-versed in multiple specialties and trained and sub-specialized.  They review the dictated report provided to be certain the proper code is used when billing, as well as, ensuring that the documentation is complete and there was not any codes or revenue missed.  Additionally, the use of certified coders, helps to assure compliance and keep the practice and physicians from over-coding.  Certified Coders stay current with any code changes including additions and deletions.
  • Billing companies make it their business to be cognizant of deadlines imposed by insurance carriers and Medicare.  Your claims will be submitted on time and objections to rejected claims will be filed within the required established time frame. 
  • Billing companies keep current on changes to rules and regulations. 
  • Billing companies employ the latest technology and software for efficiency and accuracy. 

Confirm reimbursement rate is consistent with contract terms

Some insurance companies have been known to pay doctors a discounted rate when, in fact, the doctor did not have a discounted rate agreement with the company.  For example, one practice received thousands of dollars less than what they should have received because a payor (insurance company) loaded the wrong fee schedule.  Since 2010, HIS collected more than $2,000,000 in underpayments for practices whose payments had been improperly discounted. 

Image courtesy of: Stuart Miles/