Breaking Down the Billing Cycle for Private Practices

A primary aspect of running a business is handling financials. That includes the most customer-centric companies of healthcare. While running a clinic can get easier over time, the highly technical aspect of billing can be quite daunting for your accounting department and patients alike.

Most patients have insurance companies that pay a portion of their fees, and the companies won’t pay without receiving an invoice within a set deadline. If the insurance company doesn’t pay, it’ll result in patient dissatisfaction. Even the most skilled employees won’t be able to process a large number of invoices and receipts to various insurance companies in time.

The solution to this issue is automation and software-assistance. Having a program that streamlines and perfects the complex billing process can be what’s standing between your clinic’s current status and your future vision. When software takes care of the nitty-gritty, your employees can focus on the clinic’s primary mission: providing quality healthcare for patients.

The Six Steps of Medical Billing

The billing process in the healthcare industry isn’t as simple as giving money and receiving a service. The medical billing process splits into six main steps:

  • Patient Check-in– During the check-in step, preliminary information about the patient gets collected into your clinic’s records. It includes their demographic and whether they’re a returning patient and additional contact and personal information.
  • Insurance Information– Since most patients have some insurance policy, the next step is to check their eligibility and ensure the insurance policy is active and includes your clinic.
  • Diagnosis– Having an official medical code for what the patient has or what they’re getting tested for is necessary when contacting their insurance provider. This step makes sure that the insurance covers the patient is requesting either fully or partially by their health insurance provider.
  • Charge Entry– The charges include the services and equipment that the patient received or asked for. The cost is strictly recorded using medical code for insurance eligibility and accuracy purposes.
  • Submission of a Claim– After having all the appropriate information, the healthcare providers then must send an insurance claim to the patient’s insurance provider within a set timeline. According to their agreed-upon insurance policy, this is an invoice sent to the insurance company, asking for payment for the patient’s treatment.
  • Payment Posting– The last step is the actual payment or deposit step. It gets logged into the system with the insurance company either paying fully or partially. The whole process should be complete for the clinic, the patient, and the insurance company.

Simplify the Process with Software

While six steps might not feel like much to many business owners and accountants, each stage involves several tasks. Furthermore, those six steps are just for a single visit. Each patient needs to have the process done all over again every visit, which can accumulate insane amounts of work in your accounting department, causing them to fall back on sending invoices, claims, and accurate records for taxes.

One way to streamline the payment process is automating most of it. You can start by exploring specialized NextGen medical billing software options available on the market. Having the right billing software can help your clinic:

  • Automate insurance verification and eligibility.
  • Generate and send claims using templates that suit different insurance companies’ requirements.
  • Edit claims instead of starting from scratch.
  • Analyze reports to improve on future billing operations.
  • Reduce Patient wait-time.
  • Faster payment posting.
  • Manage workload tasks.

Investing in NextGen medical billing software isn’t your only option. You can also choose to outsource the entire billing process to specialized accounting firms, allowing you to focus more on your actual business than the logistics of billing.

However, if outsourcing your finances isn’t something you feel comfortable doing, you can co-source the work. This process means that an outside firm will help with certain parts of the billing, taking in excess workload. At the same time, you stay in full control over the process.

Keep an Open Mind

There are many ways you can automate your practice, with a variety of price points and security layers. It’s up to you to decide what best works for your business, which parts to outsource, which to automate, and which to keep old-school. Worrying less about billing will allow your staff to spend more time focusing on patients’ well being and satisfaction by providing high-quality healthcare.

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