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Friday, July 12, 2024

How Outsourcing Medical Billing Services Can Minimize Claim Denials and Maximize Revenue?

Healthcare businesses should strive to generate competent cash flow to survive in fast-pacing industrial development.

They should implement proper management for medical billing services to get properly reimbursed for services provided.

An efficient medical billing process is an essential component of claim submission and follow-up cycle.

However, with the increasing emphasis on value-based documentation and strict processing guidelines established by regulatory bodies, it has become extremely challenging for medical practitioners.

Therefore, providers should consult with medical & coding subject-matter experts to device innovative medical billing solutions.

A well-experienced and HIPAA-compliant medical billing company will ensure that the process of translating healthcare services into comprehensive claims is handled by the experts of the field.

Partnering with a knowledgeable medical billing services provider can help providers minimize denials and maximize revenue in the following ways;

1. Well-Managed Patient Scheduling:

Patient registration is the primary and most important step of the medical billing process.

This complicated procedure requires collecting patient demographic information, appointment scheduling, and verifying insurance eligibility.

In this step, the front desk staff schedule patient appointments and set up for the accounts for billing and contact.

In technologically advanced medical billing companies, professionals trained in scheduling and registration process utilize sophisticated online software to book appointments, send out reminders, verify patient information, and reschedule appointments.

Efficient medical appointment scheduling improves revenue, enhances patient satisfaction, and optimizes medical billing services.

If you want  more about the significance and impact of well-organized medical reforms, I would recommend you to find your answers through the given link https://medcaremso.com/

2. Patient enrollment:

It involves the digitization of patient information. In this step, the patient information is enrolled through electronic means.

Moreover, the hospital registration system also collects information about the insurance coverage of a patient.

Proper enrollment is essential to ensure that insurance companies have access to patient information which will help to prevent claim denials and reduce payment delays.

3. Insurance verification:

Obtaining insurance verifications and pre-authorization are the most critical aspects of overall revenue cycle management.

When you outsource medical billing services then billing specialists to implement the latest industrial solutions for insurance verification and preauthorization.

Their dedicated workforce stays connected with the insurance companies. They will call insurers every time when they will come to visit your healthcare office to verify their insurance coverage plan.

They will verify all primary, secondary, and tertiary coverage and document the patient’s out-of-pocket cost to determine the patient’s financial responsibility.

Comprehensive patient eligibility helps you to avoid claim denials that can occur due to erroneous patient information.

In addition to this, when every subtle detail is fully monitored by every relevant department then it also reduces the chance of upcoding, under coding, or any abusive medical billing practice.

As a result, it is also an effective tool to drive maximum patient satisfaction.

4. Preauthorization:

Another critical aspect of medical billing services is “pre-authorization” for specific physician-ordered medical tests, clinical procedures, medications, and medical devices.

When medical billers emphasize timely preauthorizations then it prevents treatment delays and claims denials.

When billers submit claims after pre-authorization with supportive documentation then there is more likelihood of reimbursements.

Pre-authorization experts can also track down real-time authorization rules and policies as well.

While a third-party handling insurance authorization efficiently, relieves medical practitioners of the time-consuming administrative tasks.

Medical coding:

You should partner with a reliable medical billing company that has AAPC-certified medical coders in their taskforce.

Qualified medical coders have great expertise to assign the right diagnostic and treatment codes as well as modifiers on claims based on the information in the medical records.

Medical claims that are prepared by following accurate medical coding protocols best describe the patient’s symptoms or illness and the medical services provided.

Qualified and skilled medical coders have complete knowledge about the CPT, HCPCS, and ICD-10 coding classification.

In this way, the file and submit error-free medical claims that help you get completely paid for your services at the first attempt.

5. Charge entry and claim submission:

After providing medical treatment or diagnostic services, the charges for services performed are entered into the patient’s account.

Each procedure is translated into standard medical codes.

Once you outsource medical billing services, a third-party would assign this task to dedicated employees who can handle a high volume of transactions efficiently.

Before preparing medical bills, medical billers first analyze the information and review medical codes for accuracy.

Third-party medical billing specialists take the responsibility to manage complex claim submission processes, review medical claims, and edit claims to rectify errors if any occurs before sending them to insurance payers.

6. Insurance payment posting or billing and reconciling of accounts

This critical step involves posting the payments instead of claims in the medical billing systems.

The EOB (Explanation of benefits) or ERA (electronic remittance advice) sent by the insurance company to settle claims is posted immediately into the respective patient accounts.

A well-experienced medical billing specialist knows that a comprehensive medical bill (that doesn’t contain difficult medical coding jargon and extra information) is the fundamental attribute of the payment collection procedure.

It will help patients to understand their payables easily. In this way, amounts collected from patients through checks or credit cards are also correctly accounted against the claim to ensure proper closure.


Partnering with well-reputed medical billing services will add value across your business. It would help you execute revenue cycle management efficiently and accurately.

When industrial experts will take control over your administrative burden then you will also get relieved from time-consuming and burdensome tasks.

It will reinforce accuracy in your claim submission and drive maximum revenue on return.

MedcareMSO is an industry-leading medical billing company that has been serving for 12 years.

Visit our website https://medcaremso.com/medical-billing-services to learn more about our value-based medical billing services.

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