Medical claims processing begins when a healthcare professional submits a medical claim request to the insurer. When physicians provide medical care to patients, they get compensated by sending bills to insurance companies that cover medical services. There are various steps involved in this process. First, claims are created by assigning precise ICD and CPT codes to the provided medical services. These claims include crucial data such as patient demographics and plan coverage details. The claims are then filed to the payers. Each claim is evaluated and reimbursed by the insurance companies. It is a complicated task that can only be completed by skilled professionals with excellent attention to detail, extensive training in new coding procedures, outstanding interpersonal skills, and an understanding of modern healthcare patterns. Medical billing and coding efficiency are the keys to profitable payments. Healthy revenue cycle management indicates that healthcare organizations are effective. However, this paradigm is not universal. Nowadays, many healthcare offices and independent providers struggle to complete medical claims billing and processing effectively. The implementation of several healthcare reforms is one of the chief factors that have transformed the United States during the last decade.
You should be aware that your business has several possibilities for improving the coding and billing process, resulting in faster submission timelines and higher first-pass acceptance statistics. Here are a few tips for improving your company’s medical claim processing cycle.
Quality Medical Billing
Healthcare organizations should employ highly skilled specialists who perform accurate medical billing, track and correct billing issues, submit claims timely, follow up on outstanding AR, resolve denied claims, and do precise payment posting to achieve efficient medical billing operations. If an organization’s in-house medical billing team is inefficient at performing these services, it can choose to outsource medical billing for sophisticated healthcare claims processing.
Denials Management
Consider that you must evaluate if your quarterly report shows a drop in sales due to too many rejected applications. Properly implemented denial management increases profits when funds are delayed due to problematic claims and improves the medical claim process cycle. By paying attention to some of these criteria, your medical practice should try to reduce denials.
Update Patient Information
Patient demographics and insurance information change regularly. As a result, before initiating medical claims processing activities, the in-house medical billing staff must ensure that patient information is kept current and accurate. This significantly eliminates medical claim denials, hence improving the medical claims processing cycle.
Automate Basic Billing Functions
Encouraging employees to perform things more readily with automated technologies is a drain on your organization. It lowers morale and discourages personnel who could otherwise focus on providing more patient-centered, personalized service. Instead, identify regular and monotonously repetitious invoicing activities.
For example, individual claims must be filed, payment reminders must be issued, and assistance in determining the appropriate medical billing codes is provided.
AR Follow-Up
One of the leading causes of poor medical claims processing management is the accumulation of AR. Therefore, healthcare firms should engage specialized AR management staff to guarantee that denied claims are tracked and appealed on time. This team will handle all activities competently, from evaluating and ordering to demanding and collecting money. If your healthcare institution lacks a specialized AR management staff, consider partnering with a medical billing provider that does.
Outsource Your Complex Collections
As an organization that has been providing network services for decades, you and your fellow investors may be hesitant to outsource work. However, staying optimistic is prudent, especially when your sales cycle’s success is at risk. Working with a third-party revenue cycle management services provider frees up your personnel while specialists handle more problematic collections.
Keep Track Of Denials
Whether a practice uses an external medical billing and coding provider or processes claims internally, it is evident that having a system of established checks and balances will increase first-pass rates. Instead of criticizing personnel for errors, adopt the mindset that every rejection is a chance to enhance the procedure. When you find higher-than-expected denial rates, it could indicate that you need to provide additional training to your staff or that your scrubbing procedure is insufficient for your present workflow. Tracking denial codes may reveal simple steps your practice can take to improve efficiency.
Improve Quality Control
Reducing claim errors is crucial for the financial health of your clinic. However, the billing and collection procedure does not end once a claim is accepted. Using generally recognized accounting principles to post and record payments allows medical providers to monitor cash flow. Create a deposit log for each transaction and send it to the billing team to enhance account balance stability. The record must include all data required to ensure appropriate posting and allow a supervisor to quickly confirm correct payment amounts and send them to the corresponding accounts.
Train For Success
Every insurance provider will have its own business policies. An insurance company may require you to send chart notes with a new patient’s claims to start a primary care relationship. On the other hand, some insurers request chart notes primarily to support follow-up care and non-standard methods of treatment. Update and enhance your employee training programs to incorporate components that allow billing departments to identify essential filing requirements and access patient information rapidly. This ensures that each carrier receives the information required to speed up claims processing as soon as you file them.
Optimize Your Medical Claims Billing Process Today
The sustainability of your organization’s bottom line needs to educate your personnel and provide them with the necessary tools to address effective claims processing. There is much information to learn before you and the rest of your team can truly make the most of modern-day billing software and services. Finally, examining the medical billing cycle from the initial patient contact through check deposit can allow you to streamline the claims process and obtain reimbursements more efficiently, hence enhancing cash flow. There is no question that back-office operations and roles in the medical claim processing cycle are essential to the success and growth of your firm. Outsourcing your medical billing operations is one of the finest strategies to optimize your medical claim processing cycle.
There are numerous advantages of outsourcing these activities. If you need to outsource medical billing and coding, go no further than I-Med Claims, a one-stop shop for all your requirements.
