Medical Charge Reconciliation: Ultimate Guide for Finance

Medical technology evolves and innovates at a rapid pace. Similarly, so does accounting and finance software that exists to assist medical companies in automating their key functions, such as medical charge reconciliation. 

With the use of finance automation software like SolveXia, the healthcare claims reconciliation process can be streamlined, accurate, and hassle-free. 

Let’s take a look at what the billing reconciliation process entails, as well as how software can help. 

Coming Up

What is Medical Charge Reconciliation?

What are Common Challenges with Medical Charge Lag?

What is the Medical Charge Reconciliation Process?

What are the Benefits of Medical Charge Reconciliation?

What Questions Should You Ask About Your Charge Reconciliation Process?

How Often Should You Do Medical Charge Reconciliation?

How Automation Tools Can Help with Medical Charge Reconciliation?

What are Best Practices for Medical Charge Reconciliation?

What Tools Can Streamline the Medical Reconciliation Process?

Final Thoughts

What is Medical Charge Reconciliation?

Medical charge reconciliation, also known as revenue reconciliation, compares healthcare services costs against the amount that gets charged to patients to make sure it is correct. 

By doing so, medical providers can ensure that the services provided are being accurately reflected on bills. Without performing medical charge reconciliation, healthcare providers may fail to bill for what they are owed, thereby losing potential revenue. 

What are Common Challenges with Medical Charge Lag?

Charge lag can occur for different reasons, which ultimately end up delaying the billing process. 

These reasons may include:

1. Manual Data Entry: When companies rely on manual data entry via paper-based documentation, there’s a high chance of delay because it requires that the information be uploaded into a billing system. Not only are there delays from this, but there are also likely to be mistakes. 

2. Lack of Communication: Administrative staff is typically responsible for entering the data for billing. But, if there is miscommunication between clinical staff and administrative staff, then it may result in delays and mistakes on bills for patients. 

3. Improper Documentation: When administrative staff is dealing with incomplete documentation or data, then they have to go back to the source to verify what services were actually rendered. 

What is the Medical Charge Reconciliation Process?

The medical charge reconciliation process requires attention to detail that all begins with appointment reconciliation. 

Here’s what it looks like in practice: 

1. Status Updates

First, providers should ensure that appointments that are on the books are confirmed. If they are canceled or moved, then the records should accurately reflect the adjustments so that the billing and accounting department won’t expect to bill those patients for any services just yet. 

2. Charge Release

Once a patient does arrive to receive services or treatment, it’s up to the office to release the charges from their Electronic Healthcare Records (EHR). 

3. Reconciliation

With everything properly documented, it’s time to compare these documents with the charges being billed. By doing so, providers can confirm that patients are being billed accurately for the services that were rendered. 

If mistakes exist, it’s of utmost importance to investigate the reason for the discrepancy and rectify it. To resolve errors, you may have to contract the insurance companies or update records to resubmit claims. 

The field of healthcare can undoubtedly be complex, and the same can be said of its accounting procedures. Medical charge reconciliation needs to be a clear and consistent process in order to not fall behind, especially when you are seeing many patients and using various systems for documentation. 

When using finance automation software like SolveXia, medical charge reconciliation becomes seamless and direct.  SolveXia helps to manage complex sales cycles and multiple revenue streams, while ensuring compliance with financial reporting standards. 

When it comes to insurance claims, SolveXia will automatically reconcile the claims, which means you can mitigate the chance of insurance delays and claims denials. By processing payments in a timely manner, providers are able to reduce delays overall. 

What are the Benefits of Medical Charge Reconciliation?

If you wish to accurately receive the revenue that you are rightfully owed, then medical charge reconciliation is an absolute must! 

Reconciliation assists in:

1. Spotting Underpayments

In some cases, insurances may underpay what they are supposed to based on their policies. If you receive an underpayment for a bill, then medical charge reconciliation will help identify the underpayment so you can take action to be paid in full. 

2. Detecting Overpayments

In the same vein, overpayments are a possibility, too. If they occur, it’s up to the provider to return the extra funds to remain compliant with regulations. 

3. Dealing with Denials

Insurance companies may deny claims. If they are rightfully supposed to cover a claim, then medical charge reconciliation will confirm it’s time to appeal. 

4. Getting Paid

Most importantly, consistent medical billing reconciliation aids in getting paid the right amount in a timely manner. Of course, this is crucial for healthcare providers that wish to maintain financial stability and adequate cash flow. 

What Questions Should You Ask About Your Charge Reconciliation Process?

When implementing or even improving upon your charge reconciliation process, it’s helpful to ask a few useful questions, including: 

• How are we monitoring charges?
• Are all the steps of the workflow useful and needed?
• Is the workflow automation software set up to trigger the right actions at the right time? 
• Are there any other areas in which we can add automation to expedite or streamline the process? 
• Are our reports adequately reflecting everything we need to know? 
• Are there any steps that we can remove from the process to streamline or enhance it further? 

How Often Should You Do Medical Charge Reconciliation?

Reconciliation is a process that should be done on a consistent basis, no matter what kind of reconciliation we are talking about. However, every company has its own standards and practices that it puts into place. 

To determine the frequency at which you should perform reconciliation, it’s helpful to know that the longer you go without it, the more likely you are to face bigger issues and risk not being paid on time. 

In an ideal world, medical charge reconciliation would take place daily. When performed manually, this feels like a longshot. But, with the aid of medical reconciliation software like SolveXia, everything is automated, so it’s as easy as pie to reconcile charges every day without any extra effort required. 

How Automation Tools Can Help with Medical Charge Reconciliation?

Automation tools enable the medical charge reconciliation process to flow without delays or mistakes. Solutions like SolveXia assist by:

1. Removing Manual Reliance

By reducing or entirely removing the need for manual data entry, automation tools prevent errors from occurring and charge delays from taking place. All data is pulled together in the centralized system and automatically updated to reflect what services were rendered and its according charges. 

2. Documenting in Real-Time

Healthcare providers are able to document in real-time what they are doing, with mobile solutions. As such, the risk of miscommunication between clinical staff, administrators, and accounting professionals is eliminated. 

3. Integrating with Existing Systems

With integration capabilities, these automation tools work alongside your existing tech stack so that the data and information moves between the systems freely, yet securely. Integration with EHRs means that services and corresponding charges are updated hand-in-hand. 

4. Providing Analytics and Reporting

Importantly, finance software like SolveXia offers customizable dashboards, analytics, and reporting so that stakeholders and executives can keep track of the reconciliation process. This helps to execute process improvement and eliminate bottlenecks. 

What are Best Practices for Medical Charge Reconciliation?

To fulfill medical charge reconciliation in the most optimized and successful manner, here are a few expert tips that prove to be useful:

• Ensure your team is trained and aware of the steps involved and the technologies in use for medical charge reconciliation 
• Leverage reconciliation software to streamline and automate as much as possible 
• Maintain accurate records 
• Consistently perform audits and check payments 
• Keep communication lines open between staff and insurance companies 

What Tools Can Streamline the Medical Reconciliation Process?

With the right technology in place, your company can streamline the medical reconciliation process without having to think twice. 

Some useful tools to consider implementing include:

1. Automated Reconciliation Software

We put this at the top of the list because it will prove to be the most transformative for your business. Automated reconciliation software like SolveXia automatically compares payments from insurance companies to billing records to make sure everything matches up. 

By identifying errors right away, you can remain confident that your business gets paid what it is owed every time. Additionally, your finance team can spend more time on high-level tasks and value add responsibilities, rather than having to manually compare records. 

2. Billing Management Systems

A billing management system is another incredibly effective tool to help manage all medical billing concerns, from claim submission to payment tracking. By automating follow-ups and posting payments, you never have to worry if anything is slipping through the cracks. 

Final Thoughts

Healthcare providers and medtech companies deal with medical charge reconciliation on a monthly, if not daily basis. The ability to expedite the process or reduce errors by even 1% will have a dramatic impact on your business as a whole. 

With medical charge reconciliation software like SolveXia, you can speed up manual processes by 100x and reduce errors by 98%, dramatically reshaping how critical accounting and finance processes are completed in your business to maximize revenue, reduce costs, and optimize efficiency. 

Curious to see how easy SolveXia is to use? We’d love to show you!