Overall, the entire medical billing process from start to finish should ideally be smooth and seamless. Unfortunately, that doesn’t always happen in medical clinics, whether it be a small, family-owned practice or a private network. Now, the onus is on medical clinics to be more accurate, reliable and supplement in-house personnel when needed. 

That said, what does it take to ensure that medical billing isn’t a problem when a practice can least afford it, especially during the COVID-19 pandemic? At the very least, a successful medical billing process includes the following five characteristics.

1.) Staffing requirements – How many medical billers do you really need?

How does a medical clinic decide how many medical billing professionals it needs? The answers depend on the size and scope of the practice and additional factors.

The general rule is that a single medical biller should be able to complete about 10,000 claims per year. Take for example, one medical doctor will bill $2m in charges annually and collect 50% on average (depending on your fee schedule) which is $1m in actual revenue. If 60% of claims process without additional review you will have $800,000 in receivables that require medical billing expertise. Moreover, if a clinic processes 30,000 claims, the required number is at least three workers. But there’s a problem when the 10,000-claims rule doesn’t work in real life.

Billing systems aren’t static software platforms; they’re constantly changing as companies add features like more robust security and privacy measures. Medical billing staff should have a moderate level of tech skills to keep pace with those updates on time.

Advanced outsource medical billing companies have proprietary technology that allows a staff person to work 4-5 times the volume with better results than an in-house staff person. Moreover, an advanced outsource partner will be able to reduce your cost while increasing revenue.

The better solution could be to outsource medical billing to streamline the process. Not every clinic can afford mistakes when posting payments, managing accounts receivable, and customer service that doesn’t go as planned.

2.) Workflow technology – Can your staff handle the load?

The bottom line is this: too many clinics across the country hire medical billing workers that are accustomed to traditional workflows and too slow to pick up new technology platforms and efficiencies. If billers can’t quickly use the software that clinics rely upon, productivity and efficiency will only plummet as the practice grows.

At the very least, a medical billing process should make it easy to create and prioritize vital metrics. Otherwise, clinics increase the risk of common clerical mistakes snowballing into serious issues.

Ideally, the perfect solution would be a platform or managed service that allows reporting specific workflows to maximum staff efficiency.

3.) Technical expertise – How does your in-house IT really support the clinic’s business operations?

5 Steps Of A Successful Medical Billing Process

For many clinics, in-house IT departments are necessary for HIPAA compliance and daily operations. It takes more than a few part-time tech geeks to meet basic standards; it takes an entire team of specialists because anything and everything can go wrong with the software. There’s simply no such thing as a perfect platform for medical billing.

That said, what’s the alternative? The answer is that a clinic initially needs to complete an honest, forthright assessment of its in-house staff and IT capabilities. The keyword here is honest.

A skilled IT staff person or department can resolve issues efficiently while maximizing productivity and security measures. Although not every practice can afford this level of IT, so many opt for managed services, which are likely more affordable in the end.

4.) Documentation of best practices – Can your medical billing system tell you how to replicate successes?

Medical billing is one of the most critical processes in the medical field, and with good reason. Without a reliable system to charge insurances for patient services, clinics have no steady income stream. What could happen is that the clinic’s finances may become too unstable to stay in business, so patients bear the brunt of that failure.

So how does a practice transform medical billing into an asset and not a liability? The trick is documenting workflows across the business office to identify which processes work and which ones don’t do the job. The downside is that not every medical billing platform allows clinics granular control down to the individual employee.

When refining any process, whether it be manufacturing widgets or managing a medical clinic’s billing, success depends on seeing which steps are showing tangible, measurable results. When those results come to light, any practice would do well to replicate the win, and that can’t happen without proper documentation of best practices.

5.) Staff allocation and cross-training – Is it worth it to account for vacations and sick time?

The short answer is: yes, it’s worth the effort to cross-train employees on medical billing systems, even if it isn’t their primary job. As mentioned above, staffing shortages and lack of tech-savvy are two of the most common ways to fail a medical billing process. The goal is to keep the process going smoothly even when the medical biller isn’t on duty to avoid bottlenecks and unplanned downtime.

At New England Medical Billing, we know first-hand how challenging it is to optimize a medical billing process. Our services include everything medical clinics need to solidify best practices and raise efficiency to new heights. The best part – we can reduce your 

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