Getting paid for medical services is very important to sustain and maintain financial stability for any medical practice or business. Before submitting a patient’s claim to their insurance carrier, some things must be done to ensure that your return for services provided will equal reimbursement. You may be saying, I already know this, so what’s the point?
Well, claim denials increase yearly. While it is difficult to pinpoint the specifics of claim denials nationwide due to different specialties and demographics, knowing the root cause of denials within your business should be easy, and if it's not, then it's time you figure out where your biggest discrepancies are. These 5 tips can help you put some of those discrepancies to rest so that you can identify other areas that may be needed for improvement.
Check out these 5 things you should do before billing your medical claims:
Make sure all patient information that you receive is correct. Be sure to gather all patient information by making sure all patient forms are filled out correctly. This includes names, addresses, dates of birth, insurance information (if any), etc. Also making copies of the patient information can be beneficial (i.e. patient ID or driver's license, insurance card, etc.) That way you have these items on file and can refer back to them when needed. Also, it is necessary to have the patient sign all provider forms to ensure they are aware of any financial policies that they may be responsible for in light of their insurance company processing the claim according to their benefits.
Verifying patient coverage with their insurance carrier is important to the claims process. Be sure to obtain the status of the patient’s insurance, effective and termination dates, as well as what the patient’s benefits cover. This can result in either paid or denied claims based on this factor. If the patient does not have any insurance coverage, it is the patient’s responsibility to cover the cost of services. Make sure the patient is aware of this before services are provided.
During the process of verifying insurance active coverage for a patient’s insurance plan, be sure to know if a patient’s insurance requires a referral or prior authorization before services are provided. This will certainly eliminate the possibility of a denial if this was not obtained before services. Not all insurance may require a referral or prior authorization, so no other action would be required for this step.
Reviewing coding on claims is essential to following insurance and federal guidelines while staying compliant. Coding consists of procedure codes, bundling/unbundling codes, diagnosis, and modifier usage. All things should be considered and reviewed before submission to ensure claims are billed as accurately as possible.
The last thing is to confirm the mailing address for claims submission to ensure the claim will be received and processed accordingly. The most efficient claim submission is to submit claims electronically, making sure the correct Electronic Data Interchange number is correct within your billing system to submit the claim to the correct location.