Leaving Millions On The Table. Then Implement These Clinical Billing Solutions

October 21, 2021, bestturtlebeach

Just like other businesses, consistent cash flow is also crucial to keep a healthcare practice running smoothly. Without having enough revenue in hand, a  practitioner can never meet even basic medical expenses. Here’s a question that arises; how can practitioners ensure maximum revenue collection? The answer is obvious. The financial stability of a healthcare business is highly dependent on the effective management of the revenue cycle. Therefore, providers should look for advanced clinical billing solutions that best meet their financial needs.

One can’t deny the fact that excessive claim denials/rejections are the biggest reason behind losing millions of dollars annually. A medical claim can get denied due to the following reasons:

Missing or incorrect patients’ demographic information.
Lack or no medical documentation that supports medical necessity.
Invalid insurance information/ lack of prior authorization.
Incorrect translation of patients’ diagnosis, symptoms, prescriptions, treatments, medical equipment and procedures into alphanumeric standard medical codes.
Use of incorrect modifiers to describe additional healthcare services.
Duplicate Billing.
Failure to file the medical claims in a given time window of the insurance agencies.

No doubt, due to the growing complexities in billing and coding procedures, claim denials have become a common phenomenon. But if the denial rate exceeds the specified limits i.e. more than 7 percent. Then it eventually can push your clinical lab practice towards the verge of a critical financial crisis. Denied claims not only results in revenue loss for the healthcare services provided to the patients. But it also increases the financial burden of the practitioners.

Because the rework cost per claim is approximately 25$. So, imagine the financial burden associated with the reworking of a pile of unresolved medical claims. In addition to this, reworking on a denied claim can also increase the administrative burden of the healthcare staff. Sometimes, due to the lack of time and insufficient budget, the denied/rejected claims are left unattended. And clinical practitioners lose a significant amount of their hard-earned revenue permanently.

As the resubmission of a rejected or denied claim is far more complicated and hectic as compared to submitting the claim for the first time. Healthcare practitioners should implement cutting-edge clinical billing solutions to shift their practice from denial management to prevention. Implementation of the following strategies can streamline your clinical lab billing services and prevent future claim denials or rejections.

Integrate EHR Solutions

Gone are the days when practitioners were used to relying on the least effective manual methods. Such as; patients’ scheduling, registration, keeping and exchanging the healthcare data to ensure the successful execution of the clinical billing and coding tasks. Using the orthodox method always leaves a huge room for errors. That eventually results in the claim denials and revenue loss.

However, in this modern era, one of the best clinical billing solutions to enhance the efficiency of the entire revenue cycle management is the implementation of the smart Electronic Health Records (EHR). It has the potential to automate the clinical billing process from patients’ scheduling to payment posting. EHRs are the best way to keep the healthcare data in a secured digital form. It can help practitioners in the following ways:

Enable providers to get real-time access to the error-free, updated and complete information about patients’ medical histories, MRI/X-ray reports, laboratory results etc, at the point of care.
Ensure the secured exchange of health information with other clinicians and patients for more coordinated care.
Increase the efficiency and accuracy of medical documentation. Which eventually helps coders and billers to prepare error-free medical claims.
Bridge the communication gap between patients and providers by providing access to the patient’s portals. 
Protect the highly confidential health information from misuse, theft or cyberattacks.

File Clean Medical Claims

As we have already discussed, clean medical claims are the key to get maximum reimbursements from the insurance companies. However, without the assistance of well-trained billers and coders, practitioners cannot achieve the high rate of the claim first pass acceptance. So, hire efficient teams for this purpose.

After acquiring the help of industry experts. You should make sure that your billing staff implement the best in class clinical billing solutions to set the claims free from potential errors that can lead to claim denials. After double-checking for errors, billers should file the medical claims in a timely manner. Then they must keep following up with the insurance companies until providers get paid. 


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