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Failure to capture accurate Patient Information leads to Claim Reimbursement Delays

March 24, 2017



Failure to capture accurate Patient Information leads to Claim Reimbursement Delays

The main objective of a Physician from his medical billing and coding team is to ensure that there are no delays in the claims reimbursement cycle. But, in fulfilling this objective common billing errors, both human and electronic can become a major cause of concern in the Revenue cycle. Since, the procedure of medical billing includes two amazingly vital components, which is health and money, it's essential to diminish as many errors as possible and capture the accurate patient information.

Medical Billing is the backbone of your practice

Medical billing and coding is the foundation or backbone of your Revenue Cycle Management, however many providers encounter critical difficulties with effectively and precisely charging patients and payers for administrations they perform.

The medicinal charging procedure can be an agony point for a few physicians since it includes an array of healthcare stake holders and each progression to getting paid depends on the past interactions. Healthcare organizations should communicate across departments and payers and additionally ensure that vital patient data is appropriately captured for a streamlined reimbursement cycle.

In spite of the long and tedious undertaking, successful medical billing is fundamental for enhancing your facilities bottom line and decreasing days in Accounts Receivables.

Failure to capture accurate Patient Information leads to Claim Reimbursement Delays

  • The billing procedure for the most part begins at the initial point of contact between a patient and a healthcare organization. Amid this communication, your front-end staff should gather patient data that will establish the framework for billing and collection.
  • From a revenue cycle perspective, getting the most accurate information up front starts with patient scheduling and patient registration. This provides the groundwork by which claims can be billed and collected in the most efficient and effective manner possible.
  • The last thing the physician expects is getting a claim submission kicking back to them then having to work their way through the institution. If you get the information up front in as pleasant a manner as possible, it saves problems for the patient and family, if the claim is processed and cleared in a judicious manner.
  • While ensuring a patient's geographical data is effectively put into the facilities billing system is fundamental, it is also vital that front-end staff additionally confirm health insurance coverage and status.
  • Recent study involving claims denials found that eligibility or qualification issues are the top reasons behind claims being denied, and around 80 percent of cases submitted are rejected on account of qualification issues. The study expressed that providers were not asking patients and insurance agencies the correct inquiries in regards to eligibility creating an increase in denials and rejections.
  • Physician facilities should ensure that the front end staff working with them, which is vested in taking down patient details is a group of qualified personnel. Also, if the errors in billing and coding are proving to be a headache for your facility, allotting the services to an offshore billing company.
  • While ICD-10 execution went smoother than anticipated for most healthcare providers, but coding errors are as yet a critical test for some of them.

Appealing the Denials

Despite your best efforts to optimize the billing process, some of your claims will still be denied. When that happens, take steps to resolve the denied claim.

  • Identify the reason for the denial. When insurers return a claim without paying it, they'll include Claims Adjustment Reason Codes (CARC) that explains why the claim was denied. Although it sounds forthright, just read the code and correct the problem.
  • It can be challenging to interpret the CARCs because they're in alpha-numeric form and vary by insurer. Therefore, your billing staff needs to keep track of what the codes mean for each insurer.
 

Category : Revenue Cycle Management