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Top Ways to Maximize Reimbursement

Revenue success starts at the front desk! With insurance eligibility and benefits and proper coding you can set your revenue cycle up for success! It’s important to ALWAYS have a plan.

Decreasing revenue and staffing shortages have become common in recent years due to COVID and other factors. 49% of medical practices say their time in A/R increased in 2021 while the amounts being collected decreased.

A medical practice is at its foundation, a business. You can’t keep the doors open simply by providing high-quality care and excellent customer service. A critical component of successfully managing a medical practice is consistent and effective management of the revenue cycle.

The Healthcare Financial Management Association (HFMA ) defines the revenue cycle as “all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.” The revenue cycle process begins when the patient schedules an appointment and ends when all payments are collected.

At MediSYS, one of the factors that allows us to maximize reimbursement is that we have an experienced team of billing specialists who focus solely on the business aspects of the clinic – the revenue cycle. Since we have a team of people, we have the resources to be able to provide a consistent high level of service.

In this newsletter, we will cover 4 ways to maximize your reimbursement and get the most for your practice through revenue cycle management.

1 – Insurance Eligibility and Preventing Claim Denials

According to a report published by Change Healthcare, 23.9% of claim denials are due to errors during front-end revenue cycle processes, such as registration and eligibility. Therefore, almost one fourth of all claim denials can be prevented on the front end.

Insurance verification is vitally important for front desk staff to check everything before the patient comes into the office to be seen.  MediSYS RCM staff provides a second verification prior to keying any charges for a patient to make sure that the insurance on file is active and correct so the claim transmits cleanly and won’t deny for invalid payer information.  If the insurance is not correct on the patient account, we also will check the EHR system and/or notify the client to get updated information so that the claim can be filed to the correct payer up front.  This is how we can catch any errors or missed information prior to filing of claims as we want to ensure that we are meeting all requirements for a successful first pass of the claim cycle.

2 – Proper Coding

Proper coding ensures that the physician is capturing all billable services that can be billed. This can be done, by having routine claim audits to make sure all procedures are being billed appropriately and ICD 10 codes are linked correctly and coded to the highest specificity.

  • Staying up to date with coding changes and insurance policy changes. For example, ICD 10 codes are updated each year effective October 1st. CPT codes and HCPCS codes are updated each year on January 1st. MediSYS attends many coding update seminars and insurance company seminars to ensure that we can keep our clients informed and up to date of any changes that are coming.
  • Using customized claim editing software. MediSYS has several different ways to customize claim edits through MediSYS software. These are customized based on insurance guidelines, with Medicare, Medicaid, BCBS and other commercial insurance companies. Customized claim editing software ensures accuracy and efficient claims submission for quicker payment turnaround time. Utilizing these tools allows us to maintain a 99% First Pass Acceptance Rate. Contact us for more details on our clearinghouse and claim scrubbing software options.

3 – Resolving Outstanding A/R – Denial Management

The best way to work A/R is to do so proactively.  If your claims are clean when you file them, you greatly reduce the chance of a denial.  The use of a scrubber is recommended as it will catch possible denials for invalid ICD-10 diagnosis, missing/invalid modifiers, billing fees that are lower than the Medicare allowed amounts, and E & M services provided in a surgical global period.  Also, clearinghouses will provide an added layer of scrubbing and give you more detailed information.

“Should you receive a denial, work it when you post it. In addition, look for trends in your denials. “

– Philip Allen, MediSYS RCM Manager

Is this denial affecting other services on the patient’s account?  Is it affecting other claims billed out to that carrier?  Is it something related to that CPT code that could affect multiple patients and multiple carriers.  For any of these scenarios, addressing them as soon as possible will help prevent future denials which in turn, speeds up reimbursement.  Sometimes the action needed could be as simple as updating a payer ID or mailing address.  Sometimes it could require research of an LCD.  And other times, you might have to call the carrier.  Any steps you take should result in changes that will either resolve other denials or prevent future ones.

4 – Maximize Patient Collections with these tips

  • Have updated demographics and insurance information
  • Always verify insurance coverage. Many Medicare patients present their Medicare card when they actually have a Medicare Advantage plan.
  • Have front desk staff ask for copays and payments on account prior to the patient being seen or at check out.
  • Use patient text. Patients receive a text as soon as the insurance payment is processed and can pay the balance from the text. Ask us for more details.
  • Set up online bill pay. Many people prefer to pay their bills online as opposed to sending a check. Ask for more details.
  • Some patients may need financial help. Work with your patients to set up a payment plan.
  • Create a payment policy and display it where patients can see it at check in.

Just a few good practices are all that is needed to improve patient collections and increase revenue.  Let us know if we can assist your clinic.  For more information on our RCM services visit Medical Billing Management Services by MediSYS (

Also watch our short video here: Join MediSYS Where The Future is Bright

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Contact MediSYS to learn more about revenue cycle management!