Important Steps When Processing Medical Billing Claims

Here’s a fact: hundreds of millions of claims are denied by insurance companies in the US every year, amounting to billions of dollars. If you don’t have an efficient medical billing claims system, just imagine how much money your medical institution or healthcare organization is losing. Perhaps it’s time to review those rejected claims, get paid for them, and ensure that rejections are avoided in the future.

Steps in Proper Medical Billings and Claims

As much as healthcare should be a right, hospitals and healthcare practitioners still need money in order to do provide services. How do you ensure that your practice or billing company stays alive? Take note of the important steps when processing medical billing claims.

After servicing the patient, your hospital or clinic submits the claims to the insurance company. There are hundreds of insurance providers in the United States alone and the medical codes can be confusing, but you have to be meticulous because a single typo or wrong letter can cause a claim to be denied. After you submit the insurance claim, the insurance providers will process it according to the plan of the patient. Then they will reject or accept it.

In the event that the claim is denied, the first step would be to identify the reason for the denial. Common reasons for denied claims include incomplete information, coding errors and omissions, lack of prior approval, co-pay etc. By following up on patients and correcting claims, resubmitted claims can be approved to prevent aging claims.

Many of the most successful healthcare institutions and practitioners in the world have hired offshore medical billing companies to handle the insurance claims. By outsourcing your medical billing, you can save time, money, and energy. It will also ensure fast cash flow and shorter claim submission turnaround. One of the finest medical billing companies in India has over 16 years of experience, and they provide end to end medical billing services such as denial management, patient registration, AR follow up, and physician credentialing, among other services.

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Details to Check during Insurance Eligibility Verification Process

The process of insurance eligibility verification is not as simple as cross-checking data. There are hundreds of insurance providers in United States alone—and they all update their plans frequently. Unchecked details lead to insurance claim denials. Unfortunately, many details fall into the cracks because hospitals, clinics, and other healthcare organizations often lack the manpower to focus on this task.

The best solution is to partner with an offshore medical billing company to prevent rejected claims. By partnering with an offshore medical billing company, your billing company or physician group saves time, energy, and money. Offshore medical billing companies in India are affordable, and since they are doing all of the medical billing, you gain more time to focus on your Client Service or patients based on your business. However, choosing the right business partner is essential in the offshore space!E-care has over 16 years of experience. We offer end to end medical billing services, from insurance eligibility and benefit verification, Demo Entry, Coding, Charge Entry, Transmission, Payment Posting, Accounts Receivable and denial management, patient registration, indexing medical records, and much more. We are ISO-certified, a member of the HBMA or the Healthcare Business Management Association, and comply with the regulations and the latest HIPAA rules.

When we go through the process of insurance eligibility verification, we receive the schedules of the patients via email, fax, or EDI. We make sure to verify the Insurance for patients two days or more prior to the encounter depending on the requirement from our client. We have highly skilled and experienced team who is capable of maintaining the TAT and accuracy over 98%!

Our team may also regularly check the schedule through the appointment and scheduling software. The next step is to verify the patient’s insurance coverage with the insurance company. This involves making calls to the insurance providers, speaking with the insurance representatives or requesting fax through IVR and checking information through their authorized insurance portals online. If need be, we contact the patients for more information. Post which, the team updates the billing system with the details of eligibility and benefits verified, such as the co-pay, coverage period and identification (member ID, group ID, etc.) The team also input other information such as deductibles and other benefits information including maximum limitations. In the event that there are issues arising from a patient’s insurance eligibility, the client is informed as soon as possible. This streamlined process will considerably reduce rejected and delayed claims and increase practice collections. It also shortens your revenue cycle.

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Healthcare Billing Solutions - A Must Have For Today's Healthcare Industry

The operational success of healthcare service providers hinges on the financial ecosystem. It is important that cash flow is maintained so as to keep the operations running smoothly. Healthcare billing solutions are rightly touted as the best foot forward for the sector. A large number of healthcare providers rely on outsourced billing solutions offered by service providers with commendable experience. Healthcare providers have witnessed better payment receivables due to adequate follow up action. Here is a quick preview of some of the reasons for the need of outsourcing healthcare billing.

Reduction in number of denied claims

Reputed healthcare billing service providers ensure that the number of denied claims is low by providing quality billing and coding. This is achieved by a twofold process – one, accurate Insurance and Eligibility verification before appointment date and two, effective and timely appeal of claims when denied. With extensive knowledge on the process and the requirements, medical billing companies ensure that the appeals are followed up with trained and dedicated resources. This in turn reaps the benefit in the form of payment.

Controlling administrative expenses

With Healthcare Industry moving towards preventative care and encouraging Value Based Payments like ‘Fee-For-Service’, ‘Bundled Payments’ etc., it is highly important to keep the Medical Billing administrative costs under control. Administrative expenses towards the maintenance of a separate billing section involve huge recurring expenses. This is in addition to the capital expenses in establishing the section. Pay perks, employee benefits, office expenses, recruitment and training expense etc., the list is quite lengthy. Offshore Outsourcing medical billing services will dispense with all these expenses. This will leave the Practice/Hospitals with resources to focus on providing better treatment to patients and Medical billing companies based in US to focus on Client Relations and expansion!

Maintaining uninterrupted cycle of billing and follow up

Outsourcing medical billing maintains the process and cycle of billing. This is primarily because of the large number of trained and experienced professionals working on these processes. This is in sharp contrast to a key person quitting the job in the billing team which is literally unpredictable. With high attrition rates and churning experienced globally, it is inevitable that a key position may fall vacant. This will lead to backlogs and the need to train the inductee fully to start functioning without errors.

Faster payment cycles

Having a dedicated team to follow up on outstanding payments ensures that the cash flow is healthy.  Accounts receivable from insurance companies requires adequate follow up to ensure that it is received on time. Healthcare Medical billing companies follow streamlined processes to send the claim. The initial screening process and verification of information from the patient helps to generate the right bill. A claim that is correct in all aspects stands a bigger chance of getting first passed, rather than having to be denied for rework and resubmit.

Offshore Medical Billing Companies have been trusted the world over to enhance operations while creating better financial bottom lines. The efficiency with which the processes are concluded and reliance on the latest information technology has spurred the success of these organizations. Outsourced Medical Billing Companies have helped Medical Practice/hospitals to drastically cut down their expenditure in Medical Billing, benefitting from the economies of scale of operations.

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How Insurance Eligibility Verification Helps Medical Practices

With healthcare being linked to insurance in most cases, it is important to verify eligibility to ensure lower denials. At the pace with which administrative procedures are executed in healthcare, it is highly possible that incorrect or insufficient information is updated during billing. This results in a tedious and entirely avoidable process of denials and delays in clearance of claims. We take a closer look at the benefits of proper insurance eligibility verification in medical practice.

Reducing chances of claim denials and delays

Submission of incorrect, or inadequate information can be resulting in claim denials and unfortunate delays. This results in greatly impacting the flow of revenue in a negative manner. It is vital that bills and claims are accepted upfront without a round of delays that may play havoc with planned disbursals. This can be achieved through a process of proper verification of all information, and diligent cross checking prior to submission.

Reduce exposure to losses as a result of conclusive denials

An improper submission of bills and claims can often lead to a conclusive denial. Such instances of write off do occur as a result of practices that are not fully compliant with procedures. There is very little that can be done after write offs, and this can have a serious detrimental effect on financial health. ‘Prevention is better than cure’ is the adage to be followed in healthcare, and it is only natural that this extends to all areas of operations in a healthcare entity.

Staying abreast of policy changes of insurance companies

Insurance companies, like all other sectors often make changes in policy. These updates need to be factored into the verification process to ensure that the changed requirements are fully met. This will ensure that the claims result in securing reimbursement as sought. Staying abreast of changes also ensures that the least amount of time is spent on billing and receipt of claims.

Verifying insurance eligibility will help restrict unproductive actions and contribute to overall success of the organization. Streamlined processes followed as per updated procedures help to maintain efficiency and revenue flow.

e-care has great expertise in handling Insurance Eligibility and Benefit verification with all types of payers across States hence can help you to lower the denials and increase reimbursement.

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Everything You Need to Know About Physician Credentialing

Utilizing the services of medical professionals with the right credentials lends confidence to patients. Beset with reports of poor medical intervention and rejected insurance claims, it is important to choose the best physician. Physician credentialing helps patients and payers of patients’ bills alike through the review of various parameters of physician competency. This concept of enrolment is explained in brief below, which will give a fair understanding of the process and its benefits.

Learn more about physician qualification and by extension, competency

The qualification of a physician can, to a certain extent is indicative of competency. Physician credentialing involves the collation of information pertaining to completion of training by the doctor and subsequent board certification. This is then followed up with verification on the authorization granted to the physician to prescribe medications.

Understanding the record of the physician

To prevent possible rejection of claims, despite the best of treatment it is safe to fulfill the process of Physician Credentialing. The record of the physician in terms of any reported or alleged malpractice in insurance claims etc., is maintained in Physician Credentialing. This will prevent the raising of objections, if any, taking into weightage, past history.

Giving the service payer a track record of the practitioner

The track record of the physician is vital information for the payer. Records such as personal history, work history, employment background etc. help the payer during the vetting process. It is an important factor that will help to keep out physicians with a record that does not meet the requisite standards.

Mitigates liability on the part of payer and hospitals

Physician credentialing helps hospitals and payers to insulate themselves from greater risk, in the event of liabilities. It is an acknowledged sign of due diligence exercised on the part of the payer or hospital. This will safeguard them against possible liabilities arising out of medical negligence.

The process of credentialing

The process begins with the submission of an application. This is followed up verification which will factor all possible details of the physician such as location details, area of specialization, focus on particular age group, proficiency in languages, affiliation in terms of hospitals and medical groups, certifications by boards and status of practice, etc. This information on verification, will generate a lot of information towards the credentialing process. Similarly, re-credentialing is a process that is mandatory after every three years. This will list out any changes post-credentialing which will be of use to either the hospitals or payers.

Physician credentialing smoothens the process for payers during the raising of bills for insurance claims. It also helps hospitals during the process of screening and employment of doctors and specialists. Not only does it fulfill the criteria as laid down by the TJC (The Joint Commission) and the NCQA (National Committee for Quality Assurance), it also helps in grading the physicians. This can be achieved by benchmarked weightage against each parameter that makes it all the more easy to make decision.

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