Best Practices for Insurance Billing – Jeremy Zug

By Jeremy Zug
CEO of Practice Solutions

Insurance Billing has many intricacies and nuances. The challenges that come with accepting insurance and managing a billing department can disincentivize practice owners from pursuing relationships with insurance companies, but with these best practices for insurance billing you can confidently accept insurance as a value-added measure to increase access to care and diversify revenue streams. Implementing best practices can streamline the process, reduce errors, and ensure timely payments. Discover the essential steps for efficient insurance billing, focusing on eligibility and benefits verification, claim submission, and payment posting.

Eligibility and Benefits

Eligibility and benefit verification is the process of confirming a patient’s insurance coverage and understanding the specifics of what their insurance plan covers before providing services. This step is crucial for ensuring that the services rendered will be paid for by the insurance company and for informing the patient of any out-of-pocket costs they may incur. Here are some best practices you can implement today to ensure your eligibility and benefits checks are accurate and kept up to date.

Best Practices for Eligibility and Benefits in Insurance Billing

Use Electronic Verification Tools

Use electronic verification tools that offer real-time patient coverage updates. Often integrated into practice management systems, these tools provide immediate access to eligibility information. Some examples include Availity, SimplePractice, or specific payer portals. Payer portals offer some of the most trustworthy verification information because they are directly linked to the client’s insurance plan. We recommend keeping accurate portal information and frequently visiting these sites for your verification information.

Update Patient Data Regularly

To keep your patient data updated, you will need to communicate with both your patient and the insurance company. 

With your patient, you should confirm at every appointment that their insurance information, address and name have not changed, along with any other demographic information. If there have been any changes, you will want to record those changes in your EHR.

With the insurance company, you will want to do an eligibility and benefits check (E&B check) at every appointment or at least monthly. Through the E&B check, you can verify that the patient’s coverage is active, learn how much they have contributed to a deductible or out-of-pocket maximum, and understand how much a patient should owe you for a session. This will allow you to clearly communicate to your patient about any payment owed for the session, generating a positive rapport with your patient by providing clarity in an admittedly confusing process.

Keep Detailed Documentation

Maintain thorough records of all information obtained through eligibility and benefit checks. This documentation is vital for resolving future disputes with insurance companies or clarifying coverage details with patients. We recommend keeping a record of the deductible, copay/coinsurance, and out-of-pocket accumulations somewhere accessible within your electronic health record system. Keeping this information in the client’s chart provides transparency to you, your biller, and your client.

Claim Submission

Claim submission is when healthcare providers, such as therapists in private practice, submit information about the services they have rendered to patients to insurance companies so that the insurance company can review and remit any necessary payment. This process involves several steps to ensure that claims are accurate, complete, and compliant with insurance company requirements, ultimately leading to timely reimbursement. Here is how you can optimize this process:

Best Practices for Claim Submission in Insurance Billing

Complete Notes in a Timely Manner

Ensure notes are completed promptly so claim submission can be completed. Many electronic health record systems require completed notes before a claim can be submitted, so the first limiting factor in timely claim submission is timely notes. Incentivizing yourself and your employees to complete their notes in 24 hours will keep your claim submission clean and straightforward.

Have an Internal Process for Claim Scrubbing

Claim Scrubbing is a process meant to catch and correct errors on claims before submission. This includes checking for coding errors, missing information, and compliance with payer-specific requirements. Generating a claim from your EHR system is easy, but reviewing the information on a claim for any errors before it is sent takes time and a trained eye. Once a claim leaves your system, it will be reviewed by a clearinghouse that performs a secondary claim scrubbing to catch other errors, but you should not rely solely on the clearinghouse’s claim scrubbing as they are a third party and not as familiar with the details of your practice.  Ensuring your claims are clean when they leave your system and will be processed quickly by the clearinghouse and the insurance company is one of your greatest assets in a smooth partnership with insurance.

Adhere to a Regular Submission Schedule

Establish a regular schedule for submitting claims. This consistency helps manage cash flow and allows for timely follow-up on outstanding claims. It can be easy to forget the easiest of tasks, so we recommend establishing a billing schedule where your billing is done at the same time every week, or every other week depending on your practice’s needs. By committing the time and resources to billing, you will never miss a beat with claims submission.

Utilize Electronic Data Interchange (EDI)

Utilize electronic capabilities for claim submission via EDI. EDI allows for faster, more accurate claim submission and reduces the risk of errors compared to manual processes.

Payment Posting

Payment posting is when healthcare providers record the payments or non-payments received from insurance companies and patients in their practice management system. This process ensures that the practice’s financial records are accurate and up-to-date, reflecting service payments. Effective payment posting is crucial for clearly understanding the practice’s revenue cycle and promptly addressing any discrepancies. Here is how you can optimize this process:

Best Practices for Payment Posting in Insurance Billing

Enroll to Receive Electronic Remittance Advice (ERA)

Enrolling for ERA allows you to leverage electronic payment posting. ERA provides detailed information on claims processing, including payment amounts and reasons for any adjustments or denials.

Know How to Read ERA/EOB

Train your billing staff to thoroughly understand and interpret Explanation of Benefits (EOB) and ERA documents. This understanding is crucial for accurately posting payments and addressing any discrepancies.

Define Your Payment Posting Process

Develop transparent, standardized processes for posting payments, handling denials, and managing patient balances. Transparent processes ensure that payments are posted correctly and that any issues are promptly addressed.

Conclusion

By implementing these best practices, private practices can streamline insurance billing processes, reduce errors, and ensure timely payments. Regularly verifying eligibility and benefits, maintaining a smooth claim submission process, and efficiently posting payments are critical to a successful billing strategy. Adopting these practices not only improves financial health but also enhances the overall efficiency of the practice, allowing therapists to focus more on patient care.

Practice Solutions connects providers with experienced mental health billers who manage all aspects of insurance billing. Partnering with Practice Solutions allows you to implement all of these best practices at once, giving you more time to focus on your patients. If you’re ready to hand your insurance billing off to the professionals, contact us to set up a free consultation!

More About Practice Solutions:

Practice Solutions has worked with thousands of providers to provide peace of mind when it comes to insurance billing, helping to maximize insurance revenue for practices. Their expert team of billers manage eligibility and benefit checks, claim submission and follow up, denial management and payment posting. Their mission is to remove the burden of billing from providers, allowing them to focus on patient care. They also educate providers on best revenue cycle management practices, giving providers the tools they need to make the best decisions for their practice. Practice Solutions relies on the collective experience of their team and their clients to provide educational content around insurance billing in addition to their billing services.

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