5 simple steps to make your claims paid in full
6/22/2022
At some point, many of us have wondered if there is "a secret formula" that eliminates all claim denials and instantly rises a reimbursement rate to 100%.
The truth is – there is none. However, there are still some effective methods that can significantly decrease your claim denials. We are pleased to share our own 5-step tactic here.
First and foremost, you need to regularly check the eligibility of your patients. This is specifically critical for those patients who come to your office for the first time. Knowing whether the service that you are about to perform is covered by a patient's plan should be your primary concern. Who wants to get a dozen of claim denials simply because a plan doesn't pay for a particular procedure?
Second, make sure that you participate with an insurance plan of your patients. And if you do not – whether his/her plan pays to out-of-network providers. Our experience shows that a significant portion of denials occur exactly because a practitioner does not participate with a plan, and there is no out-of-network benefits.
Third, set the seal on the fact that you comply with the up-to-date billing & coding regulations. Namely, you need to make sure that you bill the most specific diagnosis and procedure codes indicate medical necessity of your services. Patient's condition and the procedures that you perform on them need to be described in an accurate level of detail. No discrepancies allowed!
Fourth, do your best on your collection process, or instruct your biller to do so. Unfortunately, our world is far from being perfect. Insurance carriers may reject or deny your claims for an invalid reason, or for no reason at all. Being able to identify such inconsistencies in a timely manner is key to a quick & successful reimbursement.
Finally, keep your medical records in a good order. There is a great number of procedures that require a proof of medical necessity to be provided to the payer, as determined by the CMS. Insurances may randomly request the medical records for your claims to determine if the services that you have performed were clinically necessarily. It is important for your notes to accurately describe the clinical conditions of your patients, and to clearly indicate why a certain procedure is medically necessary.
That's it! Mastering these 5 steps guarantees very few interruptions in your billing and reimbursement flow.
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