While timely provision of medical service and patient care is the main concern of healthcare providers, many of these entities struggle to strike a balance between this and their administrative work. Busy healthcare facilities find it difficult to handle claim submission and settlement. Submitting medical claims to an insurance carrier and managing the overall claim process has to done with great attention to detail, failing which practice revenues would be adversely affected. Professional medical billing companies have experts on the job. They implement structured and well-organized processes to prevent denials and delays, and settle outstanding claims quickly.
Well Organized Processes for Accurate and Timely Claim Processing
Medical billing specialists implement the following processes to submit claims and ensure proper and timely payment:
- Accurate Coding: Accuracy in coding is necessary for the smooth processing of medical claims. Inaccurate or outdated codes lead to claim rejection. Reliable firms have a team of experienced, AAPC-certified medical coders who stay updated with the latest developments and can assign the right CPT, ICD or HCPCS codes for all treatments and procedures.
- Charge Capture: Charges are reviewed for completeness and accuracy. The charge team enters the codes and charges as they appear on the bill. The charge entries are audited for typographical or keying errors.
- Claim Scrubbing: System-based claim scrubbing is performed before submission to validate all patient information, CPT, ICD, and HCPCS code combinations. The codes are checked against National Correct Coding Initiatives (CCI) edits, Medically Unlikely Edits (MUEs), frequency allowances, and more.
- Payment Posting: ERA and EOB payments are posted daily into the billing software against the appropriate patient account. Low payments and denials are identified and necessary refund requests or appeals are generated.
- AR Management: All unpaid insurance claims and EOBs are assessed, prioritized and followed up on immediately by the AR analysts. Follow-up is handled via electronic clearinghouses, insurance websites and via telephone and email.
- Patient Collection: Patients are personally contacted to enquire about and collect the payments that are due from them. In fact, many physician practices lose out on payments from patients because they do not follow-up on these and even write them off.
- Claims Appeal Process: A dependable medical billing company will allow any claim to be written off without appealing it first. Based on the conditions of claim rejection, the medical billing specialist takes all the steps necessary to resubmit the claims and ensure reimbursement.
A physicians office needs to be focused on delivering proper treatment and care, and undertaking medical coding and billing tasks in-house would prove too burdensome. Medical billing companies have the expertise to provide professional medical billing and coding solutions and thats why they can help physicians settle claims efficiently and quickly.