Towards Cleaner Claim Submission and Realization


Despite vigilant system of medical claim submission practiced by physicians, the recent statistics released by the American Medical Association (AMA), has reported an increase in medical billing inaccuracies by 2% over the last year’s results. What is more significant is – apart from delay or denial owing to inherent error-prone claim submission – the estimated spend of $ 1.5 billion in rectifying, resubmission, and realization of the medical bills, originally returned for inaccuracies. Therefore, physicians need to realize the importance of intensifying their vigil while preparing claim sheets. While an internal check for undesirable errors can do the trick, physicians need to know the stages where these errors/mistakes get uploaded into the claim sheet. Usually, mistakes are known to happen during:

  • Patient’s insurance verification
    Patient’s insurance verification, which establishes the existence of a health insurance for coverage of their medical expenses, is the foremost thing while preparing a medical claim sheet. Acting on the presumption that health insurance is universally prevalent could land you into trouble. Therefore, physicians need to guard against any complacency.
  • Patient’s insurance authorization
    Although patient’s verification does prove their eligibility or otherwise for medical bill reimbursement, patient’s insurance authorization further screens their eligibility for coverage for the medical situation for which they are seeking treatment. Therefore, it is doubly important that physicians satisfy themselves with this authorization from the insurance carrier, and avoid getting embarrassed later on.
  • Medical Bill Preparation
    An inclusive and comprehensive medical bill preparation is the foundation to a satisfactory claim realization. Therefore, physicians need to bill for those services that are directly related to the treatment as well those that are incidental and medically deemed allowable. Practicing such inclusive and conclusive medical billing saves physicians from either undercharging or overcharging their services.
  • Medical Coding
    Perhaps the most significant area that is more prone to error, apt medical coding is the underlying factor in either minimizing or nullifying the propensity of errors. Consequently, physicians need to be thorough with the prevailing ICD coding manual for diagnostic and procedural services. Such diligent coding can only ensure accurate coding in congruence with the ICD system of medical services coding, and error-free/denial free realization of medical claims.
  • Infusing apt Modifiers
    Due to the overlapping nature of medical procedures, more often than not, medical services are increasingly difficult to define within the governing ICD codes. Such cases demand scrupulous application of modifiers to establish the necessity for overshooting the prescribed limit of medical service. Along with establishing the necessity, modifiers also enable physicians to realize medical claims inclusive of incidental or medically deemed/allowable charges. Therefore, physicians should judiciously mix modifiers wherever necessary as they can not only nullify denial factor but also improve the prospect of inclusive revenue-generation.

These indicators point out the necessity of further modifying the laborious system of medical billing management, and sprucing up with highly technological system of medical billing and payment that would effectively remove the lacunae – such as too labor-intensive, error-prone and far too fragmented – in the prevailing system of medical billing management.

But, with physicians’ focus firmly on medical care, asking for such radical shift would be too demanding. Therefore, physicians, inevitably, have to look up to tried and proven outsourced solutions in medical billing management for lending their claim-sheets with the adjective, ‘clean and honest’. During such trepidation, having been an indispensable catalyst to physicians’ medical billing management, should make the search easier. With impeccable credentials for providing error-free billing across specialties in the US, Medicalbillersandcoders also provides consultancy services for optimizing your revenue management cycle.

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