As healthcare regulations continually change, having an educated staff or outsourcing company work alongside your team will help ensure claims are paid on time while securing revenue payments. A trained and informed staff can verify insurance coverage, review patient records for errors, and utilize available technologies that will reduce the number of rejected and denied claims. Increase clean claims submissions by implementing an effective claims management process and having an educational, learning company environment.
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Verify Insurance Coverage
When submitting a claim for payment, a vital step is to ensure the patient’s insurance coverage is verified and the insurance covers any services or equipment provided. Once the coverage is confirmed, make sure to avoid common but easy to miss mistakes that result in rejected or denied claims.
Mistakes to avoid:
- Incorrect or missing patient information
- Coding errors (placing the wrong code on the form or the code and description do not match)
- A modifier used incorrectly
- Insufficient documentation
- Submitting the claim after the deadline
- Not following up. If there’s a delay in response, follow up and check the status of the submission.
Reconfirming the above details will help ensure payments are received on time with no delays. By working with an outsourcing company, like Medbill, they have an experienced and knowledgeable team who can properly train and educate your staff on avoiding common mistakes.
Knowledgeable and Trained Staff
Ensure the billing staff is adequately trained and educated on filing procedures, accessing patient data, reviewing patient data records for potential errors on policy numbers, deductibles, billing, and patient information. The billing staff should confirm the data contains updated and accurate information (including checking for typos).
When healthcare regulations change, reimbursement rates can drop significantly if the billing staff is unaware of the changes. Medbill, a trusted and educated outsourcing company, will work effortlessly to ensure claims are billed correctly and paid on time.
Industry Technology and Software
Take advantage of available industry technology or software that can help reduce claim denials. When reviewing available software options, keep this question in mind, “Will this technology or software assist the company and employee’s needs?”.
Critical software features to consider are:
- Is it capable of billing private insurance companies?
- Does it offer any specialized tools?
- Can it be used on a mobile device?
- Does it contain HIPAA certification
- Does it include competitive bidding functionality?
- Does it have an online patient eligibility verification option?
Select a technology that will increase efficiency, not create complications or more work. Medbill has a support team that can assist your back-end operations and helps to make sure you gain maximum value from your billing technology.
Implementing an Effective Claims Management Process
Creating an effective and successful claims management process begins with reviewing rejected and denied claims.
Take the following steps:
- After the rejection/denial claim was received, were there any follow-ups?
- If there were follow-ups, how many resources were used, and how much time was incurred in correcting the claim?
- If not, what would have been the anticipated paid amount had the claim been approved?
Once there is an understanding of how much money and time are lost when ineffective claims are submitted, it can show the value of having an effective claims management process. The Medbill team will look for all errors that could cause claims denial, monitor cash flow, and track deposit data to reduce your rejected and denied claims significantly. When clean claims are submitted, it will lower the workload and secure revenue payments.
Stay Current on Industry News
Create a company environment that encourages employees to stay educated on current industry news. Maintaining an educational setting will help to ensure updates and changes are quickly known. Claim submissions have different rules and requirements, and to ensure the Revenue Cycle Management (RCM) process is undisturbed, it’s crucial to stay current on all changes.
Many available news sources offer current and timely DME news. Consider the following:
- Subscribe and read trade journals and magazines
- Create RSS feeds that follow DME topics
- Read rules and regulations updates on the Centers for Medicare and Medicaid Services website, CMS.gov
- Subscribe to Medbill’s blog on the “News” section on their website, Medbill.com, where content is updated regularly.
Medbill employs personnel who are continually learning and dedicated to staying current in the DME industry.
When companies need to reduce rejected and denied claims submissions, Medbill will work alongside the current staff to train and educate them on efficient billing strategies and bring new approaches that will significantly increase clean claims submissions.