4 Steps to Reduce Loopholes in Medical Billing Process

4 Steps to Reduce Loopholes in Medical Billing Process

How long can you blame patients for having higher denial rate? The Medicare Integrity Program stress on the significance of avoiding errors occurring while getting paid for the rendered service. This has encouraged Health and Human Services and Office of Inspector General in coming down heavily on erring healthcare practitioners. You need to keep an accordance with the standard of industry and regulatory guidelines to proactively design the coding and billing policies.


More the medical system gets complicated, there are more chances of loopholes getting created. This is the case with medical billing system. You have to be accurate with coding and billing processes for meeting the requirements of healthcare providers for improving revenue cycle management. However even after taking care of the different aspect of medical coding and billing such as applying right billing codes and charges, loophole still exist in complex system that need to be addressed.

Proper monitoring and auditing of claims that are filled is the utmost step for a thriving revenue cycle. We have compiled the list of four effective steps that will help you in reducing the loopholes of your medical billing process in order to have a thriving practice.


Automate your process to reduce errors and increase efficiency. Beginning with fixing an appointment till the time you submit your claim, make an effective use of technology. Make sure to double check the procedure codes not manually but make them a part of automated system to eliminate the chances of mistakes that can be done by staff members unintentionally.


Eliminate the chance of human errors with practice management system. Remember that this system will not going to help you beyond printing reports and posting charges. A trained staff is required to meet all your requirements. For smaller and budget conscious practices, this system  is high recommended as it will allow your staff in automating charge captures, scrubbing codes and managing tasks.


Demand audit for all work that is accomplished and bill for those services that are actually rendered to the patients. This in a way means that you have to keep an eye any kind of manipulation of billing. Be extra cautious when you are billing every single component of service as opposed to using a single code for all rendered services. More simplification of these aspect in the billing process will help you in a better way. Always remember! Unbundling codes and incorrect codes are anathema for getting paid. Practice management system will signal in case of under coding diagnoses. Facilitate dialogue between coders and billers to ensure proper reimbursement.


Are you aware that not verifying insurance is one of the major reason for getting, most of the claims denials. Not cross checking with the insurance company can cost you much. You need to verify the following things with insurance provider.

  • Check the coverage period and dates
  • Assess deductibles
  • Check up Deductibles and Copayments on preexisting condition

There are various insurance policy having certain limits under it. In order to avoid errors, a check on the patient’s insurance plan is must.

The above four steps will help you in reducing loopholes of your medical billing process. Medical practitioners have to face enormous amount of medical claims. Make sure to imbibe these following points into your medical billing practice to have a thriving revenue management.