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5 techniques to improve your claim submission

Submitting medical insurance claims 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 payment process, and ensure maximum return for your business.

Denial prevention is critical for medical practices to increase the clean claim rate. Taking a proactive approach can also 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 advice from professional billers and coders who can help you improve your processes and manage your medical practice efficiently. Billing and coding professionals specialize in these tasks and undergo training and multiple hours of courses to succeed at what they do. Billing professionals also participate in continuing education to keep up with the latest billing and coding rules, ensuring they can maximize reimbursements for services rendered.

Some quick tips to implement by yourself are to identify if a code is primary, put the diagnosis code attached to the code you´re using, and make sure to add the reason for the patient´s visit. All of this is essential to submitting your claims properly. Some providers put all the information they can in the claim, but that is not going to help them 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 in this task. Make sure there are proper processes 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

Verification

Front office staff must 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’s claim begins and ends in the front officePatient insurance eligibility verification is the first—and perhaps most critical—step in the billing process. Your front office must be on point when obtaining and accurately recording all this information.

Authorization

You need 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 to pay for a patient’s medical services as part of the health care insurance plan.

If you do not obtain authorization for any service that requires it, 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 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. A BI platform can provide 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 focuses on insights that other medical billing business intelligence solutions neglect.

Our RCM and analysis platform will let you focus on your revenue metrics, determine areas for improvement in your medical practice, and monitor its overall health.

With its predictive modeling, Datalytics provides awareness of what your medical practice’s future holds. By drilling down into details, you can understand the story behind your numbers and have data-supported decision-making. 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 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.

At Health Prime, we understand the importance of submitting your claims properly to reduce your denial rate. This will allow you to 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 [email protected]. Set up a meeting to discuss how we can help you get your practice back in its prime. 

Subscribe to our Health Prime blog to stay updated on all the latest updates on running your medical practice better so you can focus on what matters most: your patients.

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