Have you ever kept track of the percentage of claims paid properly on the first attempt? For an effective medical billing procedure, claims must be reviewed and updated, accurately recognized denials reasons, and important action must be performed before proceeding. A strong claim filing procedure ensures faster accounts receivable turnover rates and improved cash flow and revenue management. Here’s all you need to know about claim submission in medical billing and how to attain clean claim rates.
An Overview of the Medical Billing Claim Submission Process
A medical claim is a procedure through which a healthcare professional submits a bill for reimbursement to a patient’s insurance company. The claim includes unique medical codes, or CPT codes, that indicate the services provided during the patient’s consultation. When a provider files a clean or error-free claim, the claim goes rapidly through accounts receivable, and payments are made more promptly.
How to Achieve a High Claim Submission Rate?
There are few points which can help you to attain high claim submission rate:
Updated patient information of claims
The clean claim relies heavily on patient demographic data. Accurate patient records are critical for providing great treatment to your patients. Maintaining correct and up-to-date patient information and medical records may make or break the outcome. As a result, first step is to check that patient information on claims is updated. Your team should thoroughly verify insurance policy details, patient demographics, and medical information before submitting claims.
Adhere to a strict prior authorization procedure
Verifying with a payer to confirm that certain treatments are authorized is a time-consuming but essential procedure. Prior authorization should be obtained before scheduling a patient visit. Prior authorizations should be obtained at least five days before the service is conducted which results in significantly reducing the possibility of claim denials.
Check patient eligibility
Checking patient eligibility at least two days before the DOS (Date of Service) will result in more accurate claim submission and fewer claim denials. This eligibility verification approach also assists healthcare providers in maintaining a healthy cash flow by improving patient care and reducing write-offs. Co-pays, deductibles, insurance effective dates, in-network/out-of-network features, and by checking other restrictions in this phase.
Use modern medical coding recommendations
Medical coding rules keeps on changing. keeping up with the latest developments might be difficult, even if you have office staff that manages medical billing. As a result, it makes more sense to outsource your medical claims billing. Medical claims billing services devote their full attention to medical billing only. As a result, they are always up to speed on any new information regarding code modifications and how they should be handled. Healthcare providers may also leverage the automation process known as electronic claim submission to handle claims quicker by installing the finest medical billing software. This phase requires the verification of ICD and CPT compatibility and the kind of filing mechanism (paper-based or electronic claim submission) to ensure coding compliance.
Know your payers and use right modifiers
Do you understand what modifiers are approved by the payers? If their program fails to detect a modifier appropriately, claims may be denied. As a result, it is essential to understand what payers will and will not reimburse. The information you must check includes using the proper modifier and the addition of the modifier to the correct process.
Maintain accurate medical records
A well-documented medical record can assist successful revenue cycle management while reducing any problems associated with claim processing and reimbursement. According to some experts, full reimbursement is entirely dependent on proper medical documentation. For speedier claim processing, data to be checked includes the patient’s prescription history, procedure paperwork, case history, and other medical records.
Last Thoughts
Claim filing procedure is a critical and time-consuming effort. The procedures outlined above may be used and adjusted as your practice grows. Outsourcing claim submission to the top medical billing service provider will raise your clean claim rate, save your overhead costs, and ultimately enhance your practice income. To learn more about CPT codes, insurance guidelines, denial codes, and modifiers visit our website www.billingexecutive.com or email us at rcmexpertz@gmail.com
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Billing Executive – a Medical Billing and Coding Knowledge Base for Physicians, Office staff, Medical Billers and Coders, including resources pertaining to HCPCS Codes, CPT Codes, ICD-10 billing codes, Modifiers, POS Codes, Revenue Codes, Billing Errors, Denials and Rejections.
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