Introduction
The COVID-19 pandemic has put an extra burden on hospitals across the country. One of the biggest factors of the catastrophic results is the claim denials. Claim denial is the term referring to a denial of an insurance company to visualize the request from the service provider based on the services provided to the patient.
According to a statistic, the claim denials are causing a reported loss of approximately 5% of the practitioner’s medical business. This rate can be minimized by the utilization of innovative hospital billing solutions. The practitioners work really hard to ensure that the claim gets paid completely. However, the payment is based on the success of a claim, which is difficult because the appealed claims are unlikely to be accepted.
In this section, I have highlighted 5 specific solutions that can maximize revenue collections for a medical practitioner.
1. Comprehensive details provided before claim submission
According to a statistic, more than half of the claim denials and write-offs happen due to inappropriate details and incorrect medical coding data during the claim submission. As a result, it is very important for the medical practitioner to be cautious and not show carelessness during claim filing. This shows that the entire information must be verified comprehensively.
The practitioner must ensure that he has innovative hospital billing tools at his disposal to conduct his tasks appropriately. With effective hospital billing solutions, they can visualize the procedures of medical coding, bundling and operational details before claim submission. This will allow the payers to receive accurate claims and will find no reason to reject them.
2. Different claims submitted on different dates
According to a statistic, a hospital biller does a massive blunder by submitting a claim to the same service provider on the same data. The submission of claims on the same dates will get rejected by Medicare Section B. Therefore, the medical workplaces must avoid these procedures and utilize innovative hospital billing solutions to ensure that the claim is already submitted or not.
The practitioner must encourage his billing staff to utilize innovative billing software for the provision of billing services. This allows them to keep a consistent track of claims and identify the reasons for their denials if required.
3. Patient’s insurance eligibility
The front-end working panel also has a massive responsibility during the claim submission procedure. If they are unable to visualize the patient’s insurance eligibility information, this results in claim denials. This means that if they are unable to monitor the payment policies, they file those claims that will not be covered by the payer.
As a result, the front-end working panel must utilize hospital billing solutions to keep in check the insurance eligibility policy and create a basic patient profile to ensure that the medical practitioner is fully up to date with all the information.
4. Timely reminders to finalize the claim submission schedule
All of the insurance payers have a specific time set for the submission of the claim. The time can be up to 10 days. As a result, the staff that is utilizing hospital billing solutions must be aware of the schedule of every payer. Additionally, the billing staff must have an allotted time where they will identify the reasons behind the claims that are rejected.
Furthermore, the practitioners can utilize timely reminders such as alarm systems to notify about the deadlines of claim submission to their billing staff.
5. Accurate medical coding
The accurate medical coding is the biggest aim of billing services. The billers must follow a clear and strategic billing policy to file their claims appropriately. If a claim has a specialized and effective medical code, there is a high chance of reimbursement collection.
However, if a payer does complete verification of a claim and identifies inaccurate medical codes, it maximizes the chances of claim denials. Furthermore, inaccurate medical codes can lead to 2 situations. They are referred to as up-coding and under coding. Up-coding is a situation in which a medical bill is assigned to an expensive medical process. Under coding is the situation in which there is incomplete information on the services provided to the patient.
Conclusion
The billing organizations must provide a comprehensive suite of billing services to maintain the collection procedure. Not only should they employ the best possible billing specialists, but also utilize the innovative billing technologies and solutions to provide comprehensive billing services that meet their standards. Additionally, there should be control measures who ensure quality billing implementation and claim submission.
Our medical billing agency utilizes effective hospital billing solutions that ensure that the patients are provided with effective billing services. We create strategic policies to ensure maximum revenue collection and economy of scale for the practitioner’s medical business. If you want to know about the innovative billing solutions and its impact on the healthcare industry, contact us today and schedule a free demo.
