8 Ways to Improve Your Medical Claims Billing Process

8 Ways to Improve Your Medical Claims Billing Process

Every medical practice produces medical claims to get paid for services. A streamlined and efficient billing process generates more profit.

However, it’s not convenient to always figure out what particular claims billing technique will work well for your office. Trial-and-error is the best approach because each patient’s file is different. 

Some organizations use advanced technology and make simple tweaks in routines to enhance their medical billing method and productivity.

Bringing the right technology and the following eight tips together will help you cost-effectively execute your medical claims billing procedures 

8 Ways to Improve Your Medical Claims Billing Process


1. Update Employee Training Programs for Success

All the insurance companies your organization deals with would have their own unique set of rules. 

On the one hand, you’ll find insurers that require chart notes just to support non-standard treatment protocols and follow-up care. On the other hand, an insurance company may ask you to add chart notes with claims for new patients to build a primary care relationship. 

Expand and update your employee training programs to add components that help bill departments access patient files and swiftly find the relevant filing requirements. As a result, each carrier has the information required to forward claims processing as soon as you submit them.

2. Keep Track of Denials

Whether a practice opts to process claims internally or depends on an external coding and billing vendor, taking advantage of a system of checks and balances will step up first-pass rates.

Take every rejection as a learning opportunity to scale up the process rather than scolding employees for mistakes. Let’s say you notice higher denial rates beyond your expectation. That could indicate your scrubbing process is insufficient for your existing workflow, or you have to provide your team with advanced training.  

Here are some common reasons for the denials:

  • You have insufficient support documentation.
  • Carriers don’t cover the codes your team uses for equipment or services.
  • Physicians are not adequately credentialed.
  • When you monitor denial codes, you may find simple steps your practice can take to improve efficiency. For instance, daily sending chart notes and billing codes to the billing departments could step up accuracy and save much time. Plus, if you come across that claims are continuously coming back for services considered to be “non-covered,” review your coding protocols and the process for verifying coverage. 

3. Automate Primary Billing Functions 

Avoid forcing your staff members to do tasks you can easily handle with automated systems. It frustrates and demotivates employees who could rather have spent that time on more personalized and patient-centric service. 

Pinpoint billing tasks that are mind-numbingly repetitive. Tasks include generating and then issuing payment reminders, filing individual claims, and helping in choosing the appropriate medical billing codes. 

4. Outsource Your Most Difficult Collections

You, as a provider, and your fellow stakeholders may be reluctant to take outsourcing work into account after offering service in the community for years. However, it’s wise to be open about it, especially when the efficiency of your revenue cycle is at risk. 

Taking help from a third-party revenue management company enables you to lower the work burden and delegate the complex collections to experts.

With sensitivity and compassion, the experts help your patients to come to terms with their outstanding bills, like setting up a payment plan. Your staff will get rid of bearing the brunt of unhappy patients who are facing issues clearing their bills. As a result, your cash flow will go up.

Do you know how to avoid surprise medical bills?

5. Explain the Collections Process Beforehand

Open communication with patients is vital for more efficient medical claims billing. Communicate with new patients about the payments they are responsible for the provided services. You may add the details to the paperwork that patients have to fill out before their first visit.

Post a sign in the reception area to make the payments system clear if patients couldn’t claim because of being unaware of your policy. To encourage timely collections, get billing details from patients that day, including a photo ID for your files and making a copy of their insurance card. 

6. Improve Quality Control

Keeping from claim errors is vital for the financial state of your practice. However, the collections and billing process don’t stop once a claim is approved. Generally accepted accounting practices to record and post payments come in handy for medical providers to keep a close eye on the cash flow. 

Create a deposit log for each receipt to send it to the billing team to take your account balance accuracy to the next level. The log must include all the information required for the ease of a reviewer to ensure accurate payment amounts are posted to the appropriate accounts and to make a proper posting.

A log entails the following basic details:

  • Patient name
  • Cash/Check Receipt number
  • Account number
  • Referral reference number or date of service
  • Amount due

7. Analyze Delinquent Claims

Answering how much money is pending to be posted to your practice will help you figure out the percentage of delinquent claims awaiting service. Dedicate at least one staff member to figure out which claims are not getting timely paid and to review account aging. 

You may find out communication issues with patients or insurance carriers after in-depth reviewing aged accounts reviewable. Consider the following questions to come up with the right solutions:

  • Is the medical coding and billing vendor working on your claims expeditiously? 
  • Are medical biller errors causing the delinquencies? 
  • Can patients easily understand your statements?

A higher delinquency rate indicates a severe problem. Fix these issues earlier while you are continuously reviewing delinquent accounts for better performance. Make sure you put patterns and processes into effect to aid your team in filing claims more efficiently to capture revenue. 

Arrange a meeting on the communication issues because there may be some issues between you and other stakeholders.

Eventually, analyzing the medical billing cycle from the first patient contact through check deposit will help you capture reimbursements more efficiently, improve the claims process with better cash flow.

8. Update & Maintain Patient Files

Have precise details of all your patients to handle claims billing accurately. Instruct your staff to verify insurance information and patient demographics at each visit. That will help you find out their current insurance providers, jobs, or whether they have coverage from new spouses.

The nature of a patient’s insurance may have changed to a less costly plan with much more out-of-pocket expenses, or upgraded to the most costly plan with lower deductibles. 

Explain the process when you update their details rather than surprising your patients with an unexpectedly higher bill. Double-check such tiresome details as the subscriber information (including the billing address for the health insurance company) and policy number. Make sure these details match up with the records of third-party payers.


Improving your medical claims billing process can save your cost and efforts. It may be a tougher task, but you can make the process seamless by implementing the above tips into your office.

Plus, take advantage of medical billing software to automate most tasks in the billing process. Last but not least, focus on maximizing your revenue and speeding up your collection time. 

If you have any questions, please comment below now.

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