Medical Billing Timing Benchmarks

Posted by admin | February 24, 2017 , (0) comments

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How do doctors know if they are running an efficient practice? Medical staff may track rates of patient recovery. Another way to determine efficiency is to compare medical billing and coding timelines to industry standards. In a 2008 interview with Becker’s ASC Review, healthcare experts proposed guidelines for ambulatory surgery centers. These guidelines may work for other practices as well.

Insurance verification

Insurance verification should be completed 3-5 days before the start of service, according to Alexandra Reyes, a RN and administrator. These days allow the patient to react to any requirements that may arise. Patients also have time to make financial decisions about the cost or co-pay of their procedure.

Coding

Medical coding should be completed within 48 hours of the procedure. Vicker Sanders of Nuetella Healthcare says the claim should reflect the same day as the coding and charging. Although medical staff are busy, a backlog of paperwork can cause problems later. Having timelines for submission gives medical staff a clear goal that allows them to budget their time accordingly.

Billing

To align with the coding timeline described, claims should be billed out within 72 hours. Sanders argues that 72 hours is a long timeframe and the goal should be 24 hours. However, situations do arise and 72 hours is understandable in some situations.

Claims Follow-up

Unpaid claims follow-up should occur at least every 28 days, until the claim is paid. However, electronic filling should be faster than 28 days. Practices can benchmark their own repayment rate and set goals for follow-up. Sanders provides an example, saying that payers that typically respond within 10 days should receive a follow-up after 15 days.

Denial Rates

Denial rates should be no more than 1 or 2 percent. Denials waste time with claim re-submissions and practices don’t get paid as quickly as they should. Other potential problems could arise with repeated errors. Medicare, in particular, looks into repeated errors and could subject clinics to fraud investigations. Meticulousness pays off for this benchmark.

Although these benchmarks are intended for ambulatory surgery centers, quick and efficient medical billing and coding has benefits across many practices. Paying medical bills has a reputation for being confusing for patients. They receive paperwork from the insurer and from the practice. Receiving all this paperwork quickly helps patients to puzzle through who needs to be paid and when. A clear process, enacted quickly enables both patients and insurers to pay practices on time.

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