As a DME supplier, you’ll always want to ensure you are paid on time and accurately for your medical services. That requires an efficient Claims-handling process — something easier said than done.
Claims management can be a time-consuming, complex, and resource-intensive investment for your company. In this article, we will explore what Claims management is, the typical steps involved in the process, and why DME suppliers may benefit from outsourcing to a service like Medbill.
What Is Claims Management?
Claims management is the process of managing and settling claims made to insurance companies for payment of medical services or supplies rendered by healthcare providers. Its objective is to guarantee that healthcare professionals are paid on time and accurately for the services they deliver to their patients.
Verifying patient eligibility, accurately coding procedures and diagnoses, sending claims to the relevant insurance carriers, tracking claim status, and following up on any denied or unpaid claims are all part of the process.
The Basic Steps of Claims Management
In medical billing, Claims management entails a series of steps to make sure all claims submitted to insurance carriers are accurate, comprehensive, and handled in a timely manner. The general steps of Claims management are as follows:
The first step is to accurately record the patient’s demographic and insurance information. The patient’s insurance coverage, eligibility, and any pre-authorization requirements are all important aspects to account for.
Medical Necessity Review
For some medical supplies, additional verification of medical necessity will be a part of the Claims management process. This is to double check that the provided DME is indeed medically necessary for the patient and therefore eligible for coverage based on policy guidelines.
The next step is to assign the proper medical codes according to the HCPCS (Healthcare Common Procedure Coding System), to denote the specific DME items rendered to the patient. Accuracy with coding is vital for successful submissions. In addition, some insurances, such as state Medicaid programs, will require special codes. Understanding which HCPCS are valid by insurance carrier is an essential step in submitting clean claims.
Depending on the criteria of the insurance provider, claims are then submitted electronically or via paper submission. All required paperwork, such as medical documents, prior authorization forms, and itemized expenditures, should be included with the claims. Claim modifiers are also used in the submission process and will vary in use from carrier to carrier. Following the billing rules of the carriers is key to clean claims.
Once the claim has been submitted, it is critical to watch its progress and follow up with the insurance provider as necessary. This involves keeping track of claim denials and resubmitting amended claims as necessary.
Because this process can be so complex, carriers may not always respond in a timely manner, so follow-up to the original submission will be needed. These follow-ups can be done through clearinghouse communications, portal lookups, or physically calling the carrier, which is typically the least efficient method.
When the claim is finally approved, payment is received from the insurance provider and posted to the patient’s account. This posting has to be accomplished on an HCPC-by-HCPC basis and can be very time consuming for manual postings. Medbill’s TrueSight software features innovative autopost functionality to fully automate the payment and denial posting effort.
When a claim is rejected, it is vital to determine the reason for the denial and take corrective action, such as re-submitting the claim with modifier corrections, additional proof of documentation or appealing the decision directly.
It is essential to monitor the Claims management process in order to detect trends and opportunities for improvement. Reports such as claim denial rates, payment turnaround times, and revenue cycle management data can provide significant insight into the overall operation of the medical billing process.
Why Should DME Suppliers Outsource Their Claims Management?
Because of the sheer draw on time and resources effective Claims management can take, some DME providers may simply lack the staff to manage claims in-house, resulting in delayed payments and lost revenue. In addition, the complexity of the process, the ever changing nature of the payers, and continually-updated regulations can diminish any team’s effectiveness. If these situations sound familiar, Medbill can help.
Claims management demands specific knowledge and expertise in payer billing rules, insurance laws, and claim submission procedures. Medbill’s team of billing experts is built to make Claims management easy. Instead of a small number of resources trying to keep up, you are backed by a whole organization focused solely on DME. Outsourcing your Claims administration can help you free up critical time and resources to focus on other elements of your business that are more pressing.
Bundling the Billing Services team with Medbill’s software package, TrueSight, can create even more efficiencies at a lesser cost than that of your legacy system.
Take Your Claims Management to the Next Level
With a staff of highly-trained experts and a tried-and-true, systematic approach to Claims management, there’s no better team for the job than Medbill.
Save money and streamline your Claims management with Medbill. Contact us today.