With the intricacies of vast networks and giving life-saving care to millions of people, ensuring proper payment accuracy at every level is essential. The United States healthcare industry’s hospitals and healthcare providers process trillions of dollars in expenditures every year. Yet, in 2016, Beckers Hospital Review estimated that nearly 80% of all medical bills contain errors.
Fortunately, payment integrity can reduce medical spending waste. It also makes it easier to improve efficiency if providers and patients can trust financial measurement in healthcare. The PracticeForces medical billing experts explain more below.
Payment Accuracy’s Role in Healthcare
Integrity measures in healthcare payments involve practical plans and procedures to check medical billing for errors and recoup any payment waste. These checks may occur before or after payment, but they exist to ensure that providers bill each patient correctly. Errors add up over time, so the right checks can prevent a substantial amount of lost revenue.
Documentation and Coding
The most straightforward payment integrity method is improving documentation and payment accuracy through thoroughness. Medical providers and patients need accurate billing to speed up the payment process and ensure reimbursement to all available parties. Education can help in this regard, especially for coding accuracy.
Documentation guidelines also support robust documentation procedures. For example, one key aspect of proper coding practice is consistency.
Can administrators easily search databases for the information they need to perform claims validation? If not, botched searches or bad information can easily compromise the integrity of the payment data.
Claims Analysis
Payment data analytics is another avenue to tighten up procedures. It reveals inefficiencies in payment schemes so that administrators can streamline the process. For example, important metrics for claims analysis include the following:
- Denial volumes
- Avoidable write-offs
- Discharged bills
- Underpayment and overpayment recovery efforts
Once the process unearths these inefficiencies, the service provider can then use the claims data to create a solution map.
Process Improvements
One crucial aspect of payment accuracy is staff feedback, which can identify bottlenecks. Getting the payment procedure right will offer the following benefits:
- Reduce billing errors
- Improve billing security
- Streamline fraud detection
- Make compliance audits easy
- Minimize revenue loss
The regulatory landscape is constantly changing, and healthcare providers should always be ready to update their payment procedures for maximum efficiency.
About PracticeForces
The team at PracticeForces provides medical billing services for all specialties, and payment integrity is one of those areas of interest. Anyone wanting tips on revenue management, service efficiency, or medical billing practices may contact PracticeForces online or call (727) 291-9217 for a quote.
