Medical billing is one of the most critical processes within a behavioral health practice. A well-structured medical billing process can protect your practice from potential risks and save you time and money.
Is your medical billing as efficient as it could be? Are you losing revenue or compromising patient care due to inefficient processes? Review our ultimate checklist for in-patient billing procedures to see where your behavioral health practice can improve.
#1 Verify patient records
Errors happen all the time with patient data, and, thankfully, it’s one of the easiest mistakes to fix.
Before you do anything, you must verify the patient’s identification and authorizations. This includes basic details like first and last name, date of birth, visit date, and location. While verifying patient records, be sure to review the insurance coverage plan and verify if the plan is active and valid for the current treatment plan.
#2 Verify provider information
Just as you verify all patient records, it’s crucial to verify the provider’s information as well.
If the provider on the patient records is fully licensed, your team must ensure the credentials are valid. It’s easy to skip this step, but it’s crucial to look into the provider who requested the treatment plan.
#3 Verify electronic health records
Crossmatch the IDs in all records and verify that all of the information is accurate. Is there any information that doesn’t match up? Are you missing crucial gaps in coverage? Is this quality of past documentation not up to your treatment center’s standards?
Verifying electronic health records will ensure you have all of the correct, up-to-date patient information, including any allergies, drug reactions, and lifestyle notes like smoking or alcoholism.
#4 Verify codes assigned and formats used
Perhaps the most important step of the process for in-patient billing and procedures is verifying the codes assigned and the formats used. Be sure to cross-check the codes against the health records as well. This is a very specific process—just one misstep can create a massive headache for the administrative staff.
if you’re in-network with an insurance provider, you may have agreed upon codes that you are allowed to utilize exclusively. Out-of-network has much more flexibility on code acceptance.
Proper coding is crucial for accurate billing and claims management, so be sure to stay updated with each insurance provider’s medical necessity criteria and their acceptance of certain codes.
#5 Claims accuracy and application process
The claims application process will differ for each case depending on the equipment needed, patient history, medical needs, and doctor recommendations. Missing information can delay claim processing, which is a headache for your staff and the patient.
Clinical documentation and the administrative and Clinical quality of the documented dates of service billing for should meet medical necessity criteria for the payer that has authorized services to bill for. It is why education and training around understanding each payers unique requirements and medical necessity criteria is paramount when documenting the services provided.
How to implement the checklist for in-patient billing requirements and procedures
Now that you have the right information, you must implement a checklist to ensure a smooth medical billing process. Here are some best practices for your treatment center to follow:
- Review the updated process and procedures with your staff
- Create a comprehensive list of all of the updated procedures
- Implement regular training sessions with your staff
- Be open to change and take note of the feedback you receive from your team
- Stay up-to-date with advancements in technology
- Assess the effectiveness of your updated procedures and evaluate the performance
There may be some hiccups along the way as you put this new checklist into practice, but that’s standard with any new procedure.
Your trusted medical billing partner
These are the building blocks your treatment center can implement to ensure the absolute maximum amount of a patient’s bill can be covered by insurance. But that’s just the start and with everything else on your plate, you may consider outsourcing your medical billing needs to a company you trust.
Outsourcing your medical billing can be one of the best ways to streamline your medical billing processes. Learn more about how capabilities at Mosaic Billing and get in touch with our team today.
