Starting your own online healthcare business is an exciting opportunity but it’s not without its challenges. One critical aspect many new clinic owners or telehealth entrepreneurs overlook is billing management. Billing management is critical for anyone running a healthcare practice. It’s a core part of the business model, and something that healthcare professionals have to get right.
Whether you’re launching a virtual practice or setting up administrative services for other healthcare providers, mastering billing is essential to ensuring smooth operations and profitability.
Unfortunately, that doesn’t always happen. Most doctors who migrate to running an independent clinic get it wrong.
That’s why we’ve put together this guide. It outlines the common billing management mistakes and, more importantly, how to avoid them. Read on to learn how to keep your business efficient, compliant, and primed for growth.
Keeping Inaccurate Patient Details
The first mistake many practices make is inaccurate patient details. They often get things wrong, like misspelt names or inaccurate policy numbers.
Fixing these issues require verifying patient information using EHRs. All entries should be double checked and preferably flagged if incorrect by software tools.
Incorrect Coding
Incorrect coding is another issue that can arise. Many practitioners provide the wrong information to insurers.
The problem with these improper codes is that they can lead to misunderstandings, fines or audits. They can even lead to exclusion from some government programs.
Therefore, always train staff on the proper ICD-10 and CPT codes. Don’t allow anyone to slip through the net, as insurers can sometimes interpret innocent mistakes as attempts at fraud.
Duplicate Billing
You also often find issues of duplicate billing in clinical practices. Many doctors bill for the same service several times, leading to clerical errors, patient dissatisfaction, and costly reversals. Again, insurers can flag these errors as fraudulent, leading to potential investigations at the practice level.
The solution is to use multiple chart audits and billing software where applicable. Most solutions on the market can now alert you to duplicate claim entries so you can investigate them further to see if they are legitimate. If they are, you can often place explanatory notes next to them and insurers can also view, along with evidence of the cost incurred.
Poor Documentation
Another mistake in billing management is poor documentation. Many practices get into trouble for things like missing medical history or poor service details. Again, these can lead to claims issues as insurers want to see this information upfront.
The solution is to use a clinical notes AI app for healthcare professionals. These are helpful when trying to centralize systems and standardize records.
Misuse Of Modifiers
You can also run into the problem of misusing modifiers. Billing for lesion excision and skin repair separately with the wrong modifier can lead to a National Correct Coding Initiative edit issue
The only way to get around this problem is to upskill staff and ensure they know what they’re doing. If you don’t, you could run into compliance issues.
Failing To Secure Authorizations
You could also run into problems if you fail to secure authorizations. Getting this step wrong could result in denied claims later on, preventing reimbursements, which could affect patients and your bottom line.
Getting around this requires putting in place a protocol where you pre-authorize with insurers, especially for large items. Some insurers are now demanding this as a strategy for them to manage and check expenses against known patient information.
Wrapping Up
Billing might seem like just another administrative task, but for online healthcare entrepreneurs, it’s a cornerstone of your business success. Getting it wrong can lead to cash flow issues, regulatory trouble, and unhappy clients or patients.
The good news? With the right tools, training, and systems, these mistakes are completely avoidable. Whether you're a solo telehealth provider or building a scalable healthcare services business, applying these tips will set you up for long-term success.
