Medical Billing And Collections: Key Steps For A Stronger Revenue Cycle

By Author: Bryan Marcus.
Total Articles: 24
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Medical billing and collections involve much more than submitting claims and sending patient statements. For healthcare practices, the process can include coding review, electronic claim submission, payment posting, denial management, accounts receivable follow-up, insurance verification, and monitoring payer reimbursement.

A structured Medical Billing and Collections process can help practices maintain better control over their revenue cycle and identify issues that may delay payments.

Understanding Medical Billing and Collections:
The medical revenue cycle begins when a healthcare service is provided and continues through claim submission, payer processing, payment posting, and collection of outstanding balances.

Each stage can affect the next. For example, an error in coding or patient information may result in a rejected or denied claim. If unpaid claims are not followed up promptly, they can remain in accounts receivable for an extended period.

This is why medical billing and collections should be viewed as a connected process rather than separate administrative tasks.

Electronic ...
... Claim Filing and Payment Posting:
Electronic claim submission is an important component of modern medical billing. Claims can be transmitted to insurance payers electronically, while electronic remittance information can support faster payment posting and reconciliation.

MGSI's Medical Billing and Collections page lists electronic claim filing and payment posting among its core billing services. The company states that, wherever possible, claims are filed electronically to support faster turnaround.

Accurate payment posting is equally important because it helps practices maintain updated account balances and identify remaining amounts that may require follow-up.

Coding and Diagnosis Review:
Accurate coding is essential for connecting the services documented in a patient's medical record with the claim submitted to the payer.

Coding and diagnosis review can help identify potential inconsistencies before or during the billing process. Ongoing education can also help billing teams stay familiar with applicable coding requirements.

MGSI states that its medical billing and collections services include coding and diagnosis review and education, supported by its experience in medical coding and billing and ongoing staff training.

Managing Denied Claims:
Denials can create additional administrative work and delay reimbursement. A denial management process helps practices identify unpaid claims, determine why they were not reimbursed, and take appropriate follow-up action.

Denial management can include reviewing payer responses, correcting claim issues, resubmitting claims when appropriate, and monitoring recurring denial patterns.

For a practice with a significant volume of claims, consistent denial follow-up can be an important part of maintaining the overall revenue cycle.

The Importance of A/R Follow-Up:
Accounts receivable represents money that is still owed to the practice. Some outstanding claims may require payer follow-up, while others may need additional documentation, correction, or appeal.

MGSI specifically includes timely A/R follow-up on unpaid medical claims as part of its Medical Billing and Collections services.

Effective Medical Billing Collections Services should therefore include a process for monitoring unpaid claims rather than relying only on initial claim submission.

Monitoring Contracted Payer Rates:
Healthcare practices often work with multiple insurance companies, each with its own contracted reimbursement arrangements. Reviewing payments against contracted rates can help practices identify potential discrepancies.

MGSI states that its billing and collections services include ensuring that practices are paid according to their contracted rates with payers.

Regular review of payer reimbursement can provide useful information about whether payments are aligning with contractual expectations.

Insurance Eligibility Verification:
Insurance eligibility verification can help practices confirm coverage information before services are billed. Patient insurance information can change, so verifying eligibility is an important administrative step.

MGSI includes insurance eligibility verification assistance among its medical billing and collections services.

When eligibility information is accurate, billing teams can have better information available when preparing and submitting claims.

Customized Management Reports:
Reporting gives practices an opportunity to review their billing and collections activity. Depending on the practice's requirements, reports can help management monitor outstanding accounts, collections, payment activity, and other revenue cycle indicators.

MGSI states that it provides customized management reports as part of its billing and collections services.

These reports can help practices identify areas that require further review and support ongoing revenue cycle management.

Why Practices Consider Outsourcing Medical Billing Collections:
Managing every stage of billing and collections internally requires trained staff, technology, time, and ongoing attention. Practices may therefore consider working with a specialized Medical Billing and Collections Company.

An external billing team can handle designated revenue cycle responsibilities while practice employees focus on patient-facing and administrative functions.

MGSI describes its team as acting as an extension of a physician practice's office staff and provides a range of billing services based on specific practice needs.

The appropriate level of outsourcing depends on the practice's size, specialty, payer mix, staffing structure, and existing billing processes.

What to Look for in Medical Billing Collections Services:
When evaluating Medical Billing Collections Services, healthcare practices can consider:

Electronic claim submission capabilities
Coding and diagnosis review
Payment posting processes
Denial management
A/R follow-up
Insurance eligibility verification
Payer contract and reimbursement review
Customized reporting
Medical practice management technology
Staff training and billing experience
Looking at these areas can help practices determine whether a billing partner can support the specific requirements of their revenue cycle.

Conclusion:
Medical Billing and Collections is a multi-step process that extends well beyond submitting claims. Coding review, electronic claim filing, payment posting, denial management, A/R follow-up, eligibility verification, payer reimbursement monitoring, and reporting all contribute to the overall billing workflow.

For healthcare practices, a structured approach to these activities can provide greater visibility into outstanding claims and reimbursement processes. Specialized Medical Billing Collections Services can also provide dedicated support for practices that want to manage these responsibilities through an external billing team.

MGSI's Medical Billing and Collections services cover electronic claim filing, payment posting, coding and diagnosis review, denial management, A/R follow-up, eligibility assistance, managed care and credentialing support, and customized management reporting.