Running a healthcare facility is more than providing top-notch patient care and saving lives. A lot happens in the backend to ensure a seamless workflow in medical settings. Billing and claims management are perhaps the most complex elements of healthcare operations because they involve numbers and regulations.

Poor claims management and missing out on the latest regulations can lead to uncollected revenues and the need to resubmit claims. Lost time through coding errors is even more painful. Statistics show that denials increased to 11% of all claims and their cost soared 67% in 2022. You can imagine how much your clinic or hospital may lose by failing to manage medical billing efficiently.

For healthcare providers, optimizing the billing processes should be a priority. Fortunately, you need not do a lot to enhance your claims management process and improve your revenues. Here are a few ways to fine-tune your billing process to cover both fronts.

Invest in Robust Billing Software


Technology can be a game-changer when it comes to improving your medical billing process. A robust billing software solution can streamline the process. Look for one that automatically verifies eligibility, increases your clean claims rate, and reduces denials and payer rejections. It can save time for your staff and enable an efficient workflow.

Consider the example of Texas mental health providers in this context. These providers have valid qualms about accepting Medicaid because it has a lower payment rate in the state. While these organizations cannot do much about regulations, they can still rework their billing processes by adopting TMHP billing solutions.

According to Millin, billing rules can be confusing, specifically for intellectual and developmental disabilities services. The best way to follow them is by adopting a software solution that updates itself when these rules and regulations change. Additionally, it should ease calculations and ensure correct claims the first time around.

Minimize Coding Errors


Coding errors are perhaps the most common hindrance to medical billing processes. Studies show that 80% of medical bills have errors, with 63% of them happening due to hospital coding mistakes. These include missing documentation, not using updated codes, use of incorrect modifiers, and non-specific diagnosis codes.

You can overcome such errors by ensuring the accuracy of data from the referring physician. Likewise, complete and correct documentation can help. Applying the proper modifiers is another measure to overcome billing issues. By implementing these measures, you can get full reimbursements instead of stressing about denied claims.

Encourage Online Bill Payments

Online bill payments can help you optimize your billing process. You can facilitate them through a patient portal. Besides easing patient experience, a payment portal promotes quicker payments and limits the number of healthcare bills sent to collections. It can significantly enhance your medical billing workflows.

From a patient perspective, an online bill pay solution enables them to review their statements and payment histories and set up automated payment plans. The system is sustainable as it creates paperless electronic statements and saves time for the medical staff.

Prioritize Rejected and Denied Claims


Did you know that denial of health insurance claims is increasing, and for the weirdest reasons? Rejected and denied claims are integral to medical billing processes, even in the most efficient organizations.

The most common reasons for rejections and delays are inaccurate or incomplete patient information, untimely submissions, claims submission errors, and healthcare plan changes. Avoiding these causes is the first step, though they may still creep in.

Processing rejected and denied claims promptly can help you handle claims efficiently. Rejected claims are easier to address because they can be resubmitted quickly. On the other hand, handling a denied claim is challenging because it has to be appealed before resubmitting. You can use the latest software to identify the reason for denial and adjust it appropriately.

Implement Real-Time Claim Tracking

In the age of digital transformation, real-time data access is no longer a luxury but a necessity. This holds especially true for claims processing, where timely updates can significantly impact both service providers and recipients. By harnessing the capabilities of modern technology, companies can revolutionize their approach to claim tracking.

One such advancement is the use of real-time claim tracking systems. These platforms offer continuous updates on claim submissions, processing stages, and payment statuses. Think of it as a GPS for your claims. Just as you’d track a parcel’s journey from a warehouse to your doorstep, now you can monitor the path of a claim from submission to settlement.

The benefits are manifold. Firstly, real-time tracking provides an immediate alert system for any hiccups in the process. If a claim gets stuck or faces issues, stakeholders can be instantly informed, paving the way for prompt intervention. This proactive approach reduces the lag between problem identification and resolution, ensuring smooth operations. For instance, consider a healthcare provider that spots an issue with a patient’s insurance claim. With real-time tracking, the provider can quickly rectify the problem, potentially accelerating the payment process and improving the patient’s experience.

Having this kind of immediate insight aids in transparency and trust-building. Clients and customers gain confidence when they know their claims are actively monitored and managed.

Train Your Team


The efficiency of medical billing processes boils down to the knowledge and skill of your team. Your staff should understand the billing process and have the necessary skills for their roles. You can provide additional training to address knowledge gaps and tools to ease their day-to-day jobs. Further, ensure they are updated on key regulatory changes and coding requirements.

Alternatively, you can consider outsourcing the medical billing process to get the burden off your shoulders. With an expert doing all the heavy lifting of medical billing, you can focus on improving the quality of patient care and experience in your facility.


Medical billing processes can overwhelm providers as their multiple components need to function as a calibrated machine. Without a proper workflow, outstanding patient accounts and increasing denial rates can ruin your revenues. Implementing these steps can help you avoid such situations and run your facility smoothly.