10 Efficient Medical Billing and Coding Practices to Maximize Reimbursement

Updated on May 16, 2024

Navigating the maze of medical billing is challenging at best, but mistakes and inefficiencies can be costly. Each year, healthcare providers lose billions of dollars due to coding mistakes and other poor billing practices. 

Mastering the art of medical billing is essential to making sure your practice gets the reimbursements due for services provided and to ensure your practice’s financial health. Accurate medical billing also contributes to an overall positive patient experience, as patients can count on clarity in their financial responsibilities. 

There’s no one-size-fits-all formula for ensuring a clean claim rate of 95% or higher, though. Rather, it takes a multifaceted, nimble, collaborative approach by an organization’s entire team. There are, however, things all healthcare practices can do to ensure the best possible outcomes.

Here are 10 effective coding strategies to make sure your healthcare practice maximizes reimbursements to ensure financial viability in an increasingly challenging healthcare landscape:

1. Review your process regularly. Medical billing is a constantly evolving process due to changes in legislation, fee schedules, procedure coverages and other items that affect reimbursements. Set a schedule to review your contracts with insurance companies as well as Medicare and Medicaid regulations on a regular basis, and make adjustments to your procedures and documents as necessary. 

Also, regular audits of your billing and coding practices serve as a crucial checkpoint. They allow you to identify areas of weakness and areas for improvement. 

2. Collaborate and communicate with all parties involved. Establishing clear communication channels between healthcare providers, coders, administrative staff and other team members is essential. It fosters a collaborative environment that not only reduces errors and streamlines workflow but also ensures patients aren’t blindsided by unexpected charges

Continuous education and training initiatives ensure all team members remain current with evolving practices and regulations and feel empowered to perform at their best. Regular evaluation of metrics, such as your clean-claims ratio, is essential too. Sharing these benchmarks with staff cultivates a sense of ownership and accountability, encouraging everyone to actively contribute to process improvements and adapt as necessary. 

3. Get basic. Recording patient information, such as their name, address and date of birth, accurately is crucial to maximizing reimbursements. Typos and missing or incomplete information can lead to delays, denials and overall frustration. In fact, according to Northwest Career College, as many as 20% of claims are denied due to inaccurate or outdated patient information.

4. Verify insurance. Getting a patient’s insurance information correct is paramount. That means verifying there haven’t been any changes at each visit, even if they visit frequently. Also, because coverage can change anytime, make sure to check eligibility for services every time even if they’ve had a procedure covered previously under the same insurance. 

5. Document everything thoroughly. Thorough documentation is the foundation for all solid medical billing. Providers must comprehensively document the medical necessity of procedures and accurately detail all services provided. Equally important is the role of coders, who must be able to accurately interpret the documentation and be accountable for accuracy. Simplifying processes and using templates can help.

6. Code correctly. With more than 10,000 unique medical codes, it’s no wonder mistakes happen. Hiring experienced medical coders and putting in place systems that include checks and balances can help guarantee their accuracy and avoid financial and legal consequences. According to the Medical Group Management Association (MGMA), reworking a denied claim costs $25 on average, which can quickly add up.

7. Bundle codes when possible. According to the American Medical Association (AMA), unbundling is one of the most common coding mistakes healthcare providers make. Instead of using a separate code for each component of a procedure, a single code that encompasses them all should be used when one is available. While unbundling may lead to larger reimbursements, it can also serve as red flags to auditors, posing risks to your bottom line and reputation in the long run. 

8. Eliminate upcoding and undercoding. Both upcoding (inflating reimbursement requests with additional services or more expensive ones) and undercoding (not seeking enough reimbursement) can impact your bottom line, even when unintentional. The former can land you in severe hot water, too. The AMA provides an example of a psychiatrist who billed for more time than he actually met with patients. He was hit with a $400,000 fine and excluded from Medicare and Medicaid. 

9. Review denials and rejections. No matter how solid your billing practices are, denials are still inevitable. When a claim is denied, it’s important to understand why. If it’s due to a coding error, incorrect billing information or another oversight, it can be corrected and/or an appeal can be made to gain reimbursement. Many practices don’t take action, however. According to MGMA, 50% to 65% of denials are never worked, which can result in lost revenue. 

10. Embrace technology. There are a plethora of advanced solutions today designed to make the medical billing process more efficient and accurate than traditional paper methods. Technologies such as artificial intelligence (AI), predictive analytics and automation can provide insight, help prevent errors, streamline processes and optimize revenue. 

Of course, these technologies are also constantly evolving, so staying abreast of the latest trends and developments and regularly evaluating your practice’s needs is essential, as well.