Health Care Management and Medical Billing Relationships

By Nitin Chhoda PT, DPT on August 15, 2012

The relationships between the healthcare management and medical billers are important. It involves the whole process of physical therapy billing.

Nitin Chhoda reveals certain areas where healthcare management and medical billers should support each other for the success of the practice.

health care management and billing relationshipsDepending on your first hand experience with medical billing, it may be completely obvious that health care management and medical billing are very closely integrated.

However, many health care practice management professionals who have no experience in medical billing can cause problems for medical billers if they do not educate themselves on the relationship between the two.

Small Practice Medical Billing

In a small practice, it’s very likely that the medical billing will either be hired out to a separate company, or that it will be handled by the health care management staff.

These days it is easier to both hire out as well as accomplish medical billing jobs in-house as part of a position with other responsibilities. But this can cause a lot of problems when that single staff member starts to get overwhelmed.

Medical billing is the most important part of running a medical practice, besides actually treating patients. Health care management involves being able to detect the signs of an overwhelmed medical biller before it causes serious problems. Everyone in the office relies on the medical biller to bring in the payments that keep the practice running.

Health Care Management Indicators

There are a number of indicators which may tell health care management that the medical biller needs more support or more time to do their job correctly. Sometimes changes in workflow can bring efficiency up, but often it is more a problem of being overworked than anything else.

Health care managers who don’t realize how much time it takes to complete the medical billing in the way it should be handled are likely to overwhelm their staff unknowingly.

health care management relationshipsOne way that health care management can identify a problem is by looking at rejections and denials from insurance companies.

This is a tough indicator, because the average rejection and denial rate is about 50% of claims. However, with an advanced EMR you can get more detailed information.

Why has a claim been rejected? How often are rejections and denials due to clerical error, time restriction problems, or incorrect medical coding and health care management? These are the kinds of errors that occur when the medical biller doesn’t have the time to review their work before submitting claims.

Aging Reports

Another indicator are accounts receivable aging reports. Aging reports will tell you how long it takes for claims to be paid. It can also tell you whether or not medical billing and health care management staff is taking the time to review the accounts receivable aging reports regularly enough.

Sometimes payments are delayed or even overlooked because the claim has been sent, but was never received by the insurance company.

Sometimes the rejection or denial is sent incorrectly and the practice will have no way of knowing that this is what happened. Unless someone runs an aging report and checks with the insurance company to determine the status of the claim.

Medical billing involves a lot of duplicate work and communication. Health care management principles can ensure that this work is done correctly by giving medical billers the time to do their job.

About Nitin Chhoda PT, DPT

Nitin Chhoda PT, DPT is the CEO of In Touch EMR and In Touch Biller Pro, an electronic medical records and medical billing software system built be leaders in the physical therapy software industry, with thousands of satisfied customers across the world. For more information, please visit www.InTouchEmr.com and www.InTouchBillerPro.com

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