How to Do Medical Billing and Collections: A Simple Guide

Updated on July 23, 2020

About 77% of medical providers say that it takes more than a month to collect on a payment.

We already know that the cost of healthcare has gone up over the last 20 years and it’s become less affordable. It also makes it very difficult to collect on a medical bill.

You can’t just let these payments go. After all, you have a business to run and you have staff to pay. How can you get your medical billing and collections under control?

Read on to discover the way you can improve the cash flow of your medical practice by getting your medical billing and collections organized.

Know Who’s Responsible for Payment

One of the more fascinating medical billing tips stems from the fact that patients are becoming more responsible for healthcare costs. That’s a result of the cost of health insurance. Even for those that have health insurance, it seems to provide less coverage, leaving patients to foot the bill.

Before you see a patient, you need to know who is responsible for the payment, whether that’s the insurance company, the patient, or both. You can do that by getting the patient’s insurance info and make sure the insurance company will cover the appointment.

Communicate Responsibility Before You See a Patient

Patients often assume that because they have health insurance, that insurance will cover their appointment. Health insurance has become more and more complicated and misunderstood.

About 33% of Americans are concerned about affording healthcare. Sometimes when they get a large bill that they thought insurance would cover, they won’t be able to cover it.

When you understand how much of the visit the patient is responsible for, they should be made aware of that, even if it is just a co-pay.

Have a System for Billing Insurance

Insurance billing can be a nightmare for medical practitioners. One small error could result in a denied claim and a delay in payment. That will have a negative impact on your cash flow.

You want to first understand how each medical insurance provider you work with needs to get billed. Then you need to develop a system to bill them quickly and efficiently.

For example, one of the forms you’re certain to deal with is the HCFA 1500. It’s commonly used by Medicare and some private insurance companies.

Instead of filling these out by hand, fill them out using software like CMS1500. That will limit your errors and save time creating these forms.

Have a Process to Collect From Patients

There will be times when you have to bill patients for services provided. That’s part of the reason why communication upfront is so important. They’ll know to expect a bill and approximately how much.

They should be in a position to be able to pay the bill quickly which will lower your collections load.

For those that can’t pay their medical bills, there needs to be a process in place to assist patients with the burden of paying for medical care.

For bills that patients have trouble affording, you can offer a payment plan. As long as the patient pays on time for the terms agreed to, this is a simple solution.

There also needs to be a process in place for patients that don’t pay their medical bills. For example, they may get a written invoice and a second one 15-20 days later.

If the invoice is unpaid after 30 days, the patient should be contacted by phone. This type of follow up needs to happen frequently until the patient contacts you.

If there is no attempt to contact your office or make a payment arrangement, then the account may have to go to collections. Whatever system you choose has to work for you, your staff, and try to preserve the doctor-patient relationship.

Handle Insurance Denials

It’s almost inevitable that insurance will deny some claims. You want to make sure that you have a process in place to handle these denials.

Some of these denials may be due to a simple coding error. Those can get fixed and resubmitted right away. The problem is that your office staff is busy and they may not have the time to resubmit claims.

That’s money on the table.

A process to handle denials will help you get those claims resubmitted quickly and get paid faster.

Invest in Quality Staff

You have to rely on your staff to submit medical claims and get the medical coding right. They’re also the ones who will make the initial collections calls to your patients.

You have to invest in hiring the right people the first time. You also need to invest in training your staff on a regular basis to help them improve their skills.

For instance, you could invest in software training and then have another session on collections.

Develop Relationships With Insurance Contacts

As you develop your staff, you want to encourage them to develop relationships with insurance companies. 

They will also have someone to speak with when they have questions or denials. This will ultimately help you get paid faster.  

Medical Billing and Collections Procedures Improve Cash Flow                

Most businesses close because of poor cash flow. You may consider yourself to have a medical practice first, but at the end of the day, you have financial responsibilities that require positive cash flow.

Getting your medical billing and collections procedures under control will give you an opportunity to better manage your finances and reduce stress in your business. The key to getting your billing procedures under control is to have a system in place.

Read for more tips that will help you run a more efficient medical practice? Head over to the home page of this site.

The Editorial Team at Healthcare Business Today is made up of skilled healthcare writers and experts, led by our managing editor, Daniel Casciato, who has over 25 years of experience in healthcare writing. Since 1998, we have produced compelling and informative content for numerous publications, establishing ourselves as a trusted resource for health and wellness information. We offer readers access to fresh health, medicine, science, and technology developments and the latest in patient news, emphasizing how these developments affect our lives.