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Lead Your Team Strategy

6 Medical Billing and Collection Tips From Healthcare Pros

6 Medical Billing and Collection Tips From Healthcare Pros
Credit: 326098865/Shutterstock

For medical practices, there are few business operations more crucial than billing. A healthy revenue cycle is imperative to sustain the costly work of providing health care, but it's not always so easy to make sure your practice is being paid for the services it has rendered. It can be particularly challenging since health care providers are reimbursed by third-party payers after the patient has already come and gone and there is a lag between rendering services and receiving payment. Moreover, insurance claims might be rejected or denied for a variety of reasons.

So, what are the best ways your practice can ensure timely and complete payments for the work you've already done? Business News Daily sought out some experts in the health care industry for advice on how to better deal with payers. Here's what they had to say. [Related: How to Open a Private Medical Practice, Step by Step]

"It goes without saying that complete information is essential," Cindy Ehnes, vice president of COPE Health Solutions said. "Sending a claim to the right payer is critical, although in a delegated payer environment, it may be difficult to know which payer, a risk-bearing medical group, or a health plan, is responsible for payment. That can result in delay as claim Ping-Pong's back and forth."

"Bill out daily!  Don't sit around and wait for the insurance companies to pay you, but instead put a system in place to follow-up on every outstanding claim until it is fully paid," Craig Ferreira, CEO of Survival Strategies, said. "Ensure your claims are submitted correctly the first time; know in advance what the insurance company requirements are on every individual claim submitted and provide those requirements." 

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"Sometimes the best advocate is the member or policyholder of the insurance policy," Sunni Patterson, president of RMK Holdings Inc., said. "Three-way calls usually result in a positive outcome and are highly effective. If the call is static, escalate it to a supervisor."  

"Create a flow-chart of the exact steps to billing and collections.  Clearly delineate the actions that are taken at each step of the flow-chart," Ferreira said.  "Put enough of the right staff in place to do each job and train, train, train them."

"I recommend using a billing company with size and clout that is willing to be a 'squeaky wheel' that gets the grease – and the cash," Ehnes said. "Find a company that is a real advocate for those who actually heal patients. It is great to be on good terms with Payers – courtesy is essential always – the lower-level employees are just doing their jobs and can either help you or hurt you. But get a billing company that has your back." [Related: Medical Billing Services: Our Recommendations for 2016]

"Take off those rose-colored glasses and realize what you are dealing with," Ferreira said. "Know your contracts and hold your payers to them.  When talking with insurance companies, get a reference number for the phone call.  Don't be afraid to go up the chain of command.  You have to play hardball if you are up against a system that makes money by not paying you." 

Looking for more information on owning and operating a medical practice? Our medical practice guide includes everything you need to know about how to open a practice with advice from experts who've done it.

Looking for a medical billing service? Fill out the questionnaire below and our vendor partners will contact you to help you find the one that's right for you. 

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Adam C. Uzialko

Adam received his Bachelor's degree in Political Science and Journalism & Media Studies at Rutgers University. He worked for a local newspaper and freelanced for several publications after graduating college. He can be reached by email, or follow him on Twitter.