Best Practices for Medical Billing Management

The United States healthcare system can be quite complex for the ordinary person to understand due to its many policies, regulations, and changes. If you’ve had challenges navigating the system over the years as a healthcare provider, we’d like to point out that you’re not alone. One of the many complexities of this industry that is spoken about often is medical billing, and this explains why billing errors have been so widespread. In fact, reports show that over $125 billion is lost as uncollected revenue each year. It’s a recurring challenge, but one you can easily manage by following best-case practices. Here’s a look at some of them and how they could influence your medical billing management positively.

Collecting Accurate Patient Information

The backbone of every successful medical billing process is having the right information. Several data sources have revealed that one of the most common causes of rejection is incorrect information, and frankly, you can only give what you have. Taking proper patient information is one of the first steps to ensuring your claims get approved. The billing process begins at the front desk. A simple mistake, like a misspelled name, outdated insurance details, or an incorrect policy number, can result in denied claims. To avoid such issues, healthcare staff should verify patient data and insurance details on every visit.

Stay Up to Date With Relevant Coding Standards

Medical coding is the first step to a successful medical billing process. If you get it wrong, there might not be a remedy. Coding standards are very important to this process because they tell payers everything needed to make the right decision, like the patient’s diagnoses, supplies used, treatment given, and any unusual circumstances involved in the treatment process. These standards, including the International Classification of Disease (ICD), Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System

(HCPCS) should be followed closely to ensure that the billing staff follow coding updates. Also, some standards, like the ICD-10 requirements for diagnosis documentation, are more complex than the older version (ICD-9). It is very important to take note of changes like these to avoid issues like incorrect or missing codes.

Prioritize Compliance and Regulatory Updates

The medical billing regulatory compliance in 2025 is mostly driven by updates to HIPAA, CPT codes, the No Surprises Act, and the Advanced Explanation of Benefits (AEOB). Each of these elements has its role to play in the billing process. For instance, the AEOB was enacted to influence practices that protect patients from unexpected medical bills. A key component of this law is the mandatory order for healthcare providers to always provide adequate cost estimates before services are rendered. At the same time, HIPAA compliance is also crucial because it helps mandate the secure handling of patients’ sensitive information. If your staff fails to follow any of these standards, insurers may reject or delay your claim processing.

Know When to Outsource to Professionals

About 73 million of 392 million in-network claims were denied in the United States in 2023. That’s nearly one in every five submitted. The risk of having your claims thrown out or rejected is always high, but you don’t always have to handle it if things get complicated. That’s why there are countless medical billing service providers and professionals out there. Platforms like the Missing Piece ABA billing services are available to help fast-track your processes and also handle the complex parts, like submitting error-free claims, staying up to date with constant regulations, and the thousands of ICD-10, CPT, and HCPCS codes in use.

Audit Regularly and Monitor Processes

If you’re handling your process in-house, you need to carry out routine checks to keep things in order. At the same time, outsourcing shouldn’t equate to you being negligent. Routine audits are necessary to uncover inefficiencies and catch errors as quickly as possible. Results should also be monitored to know what needs to be changed or corrected. Most providers look out for key performance indicators (KPIs), like first-pass claim acceptance rate, denial rate, and average days in accounts receivable. By tracking these metrics, healthcare providers can identify recurring issues and implement corrective actions before they escalate. Also, these systems help minimize redundancies and streamline communication between billing staff and clinicians.

Building the Best Practices

The best practices in medical billing are not accomplished overnight, but by making intentional changes in your operations every day. The tips above are great places to start. Have routine checks with your staff and conduct training to improve their level of efficiency. However, if you’re looking to get faster results, you can consider hiring a professional to handle your processes for you. There are hundreds of billing service providers out there. Do your due diligence and find one that can help you get the job done. Remember to work with a licensed and authorized platform.