Implement some strategies in your medical practice to submit your claims properly,
reduce denials and optimize revenue collection.
Medical insurance claim submission is a critical step in the medical billing process. It determines the amount of reimbursement that the healthcare provider will receive from the insurance company. Submitting clean medical claims will help you reduce denials, accelerate the process of being paid, and ensure maximum return for your business.
For medical practices, denial prevention is critical for increasing the clean claim rate. Also, taking a proactive approach can help you submit your claims properly and avoid payment issues.
Here are some strategies you can implement to improve your claim submission process:
1. Understand basic coding guidelines
Healthcare providers don´t have to know everything about billing guidelines. Their focus is on providing care to patients. However, understanding the basic coding guidelines can help providers immensely.
Seek advide from professsional billers and coders who can help you improve your processes and manage your medical practice efficiently. Billing and coding professionals specialized in these tasks and undergo training and multiple hours of courses to succeed at what they do. Billing professionals participate in continuing education to keep up with the latest billing and coding rules. Doing so ensures they can maximize reimbursements for services rendered.
Some quick tips to implement by yourself are identify if a code is primary, put the diagnosis code attatched to the code you´re using. Also, make sure to add the reason for the patient´s visit. All of this is essential to submit your claims properly. Some providers put all the information they can in the claim. However, that is not going to help get their claims paid.
2. Pay attention to claim details
Clean claims must contain complete, accurate demographics and insurance details. They also need to comply with current federal and state regulations. Deficient and inaccurate data continues to be a struggle for medical practices.
According to a poll conducted by the Medical Group Management Association (MGMA), 42% of healthcare leaders reported prior authorization as the top reason for denials in their organization, followed by demographic issues (29%), and timely filing (7%). Another 22% reported “other” reasons, including:
- CPT codes (23%)
- Payer requirement inconsistencies (14%)
- Medical necessity requirements (14%)
- Missing information/documentation (11%)
- Coordination of benefits (9%)
Your front desk staff is essential on this task. Make sure there are proper processes in place to collect the data you need to bill for your services. Read more about how you can optimize your front desk on our blog Improve your front desk processes with these best practices
3. Verify Eligibility & Benefits and Authorizations
Front office staff needs to ask multiple questions to ensure they have verified the patient’s insurance and that it’s accurate and up to date. Other processes your front desk can consider when improving their verification process:
The success or failure of each patient claim begins and ends in the front office. Patient insurance eligibility verification is the first—and perhaps most critical—step in the billing process. Your front office must be on point when it comes to obtaining and accurately recording all this information.
You need to get authorization for services that require it. Authorizations keep costs in check, ensure medical necessity and reduce duplicated services. Without authorization, the insurance payer is free to refuse the payment of a patient’s medical service as part of the health care insurance plan.
For any service that requires authorization, if you do not obtain one, your claim will be denied and likely never paid. Prior authorization requirements can sometimes lead to delays or denials for care. These can cause frustration and worry for providers and patients while adding to the mountain of paperwork doctors and hospitals must do.
4. Have a Business Intelligence (BI) platform
Understand the reasons behind your denials and determine strategies moving forward based on data analysis. Having a BI platform can provide you with drill-down capabilities to help you understand the reasons behind your denied claims. Based on that, you will know where your practice is having issues and then focus on correcting those.
Health Prime’s Datalytics focus on insights that other medical billing business intelligence solutions neglect.
Our RCM and analysis platform will let you focus on your revenue metrics to determine areas of improvement on your medical practice and monitor its overall health.
With its predictive modeling, Datalytics provides awareness of what your medical practice future holds. By drilling down into details, you can understand the story behind your numbers and have decision support from data. This will allow you to make process improvement modifications in your practice.
If you want to learn more about Health Prime´s Datalytics, read our blog Datalytics: the RCM platform you need to know about
5. Hire a trustful outsourcing partner
The claim submission process is essential for your medical practice. However, it´s time-consuming and resource intensive. Relieve your practice´s administrative burden by outsourcing your claim submission process to an experienced partner.
Outsourcing medical claims submission services can help you reduce your overhead costs, optimize revenue, and improve the efficiency of your team.
Find a partner who can provide you with optimized coding services, eligibility verification, authorizations, rejection & denial resolutions, missing payments follow-up and appeals.
Read more about why you should outsource these services on our blog 5 reasons to outsource your medical billing
Follow these strategies to prevent and mitigate denials, decrease frustration, and increase your clean claim rate.
At Health Prime we understand the importance of submitting your claims properly to reduce your denial rate, so you can optimize your practice, increase revenue, and ensure that you get paid for your work.
If you want more information about how to reduce your denial rate, email us at firstname.lastname@example.org. Set up a meeting with us to discuss how we can help you get your practice back in its prime.
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