Your healthcare practice needs quick insurance payments to take of day-to-day practice expenses. With proper billing processes, it’s easier to receive insurance payments quickly. As the day passes receiving insurance reimbursements might get more challenging. In this article, we shared 7 billing processes that will help you in receiving quick insurance payments.
The patient registration process i.e., accurate capture of patient details is one of the most under-rated processes in revenue cycle management. Patient registration forms the base of an efficient medical billing process. Error-free capture of patient information is essential for clean claim submission which results in quick claims processing by insurance companies. Accurate patient and insurance information are critical to ascertain the patient's eligibility and benefits, obtaining prior authorization, and error-free claims submission. Accurate patient registration is the responsibility of the front desk team who cross verifies given details with the insurance company’s records. Patient and insurance information should be verified before the patient comes for the visit. In case of incorrect information or inactive insurance coverage, the front desk team can ask for the correct details so that the claim submission process won’t get delayed.
The term ‘clean claim’ in medical billing refers to a claim that has been filled out completely and accurately without any errors. The required details for clean claim submission include the patient's legal name, age, gender, address, and phone numbers; the patient's SSN for identification; insurance information (name of the insurance, mailing address for claims, and group and policy numbers); details of secondary and primary insurance; Medicaid or Medicare card (if the patient receives federal or state assistance); referral number; prior authorization number; procedure codes; diagnosis codes; billing information; and rendering provider information. Any inaccurate information could lead to claim denial and hence postponing insurance payments. Ideally, your clean claim percentage should be more than 95 percent i.e., only 5 claims (at max) should get rejected when you submit 100 claims.
Claim rejection occurs due to inaccurate data submission. When a claim is rejected, it does not reach the insurance company’s system, clearinghouse house rectifies the inaccurate data and sends such claims back for correction. Rejected claims are stuck in the billing software and can’t reach the insurance company until it’s been corrected. Common claim rejection reasons include payer id missing or invalid; duplicate claim; inaccurate patient information; NPI missing or invalid; invalid diagnosis codes; timely filling limit passed; and non-covered services. As mentioned above patient registration forms the base of revenue cycle management. You can cross-verify patient and insurance information using the provider portal or call the insurance rep. Some billing software also provides the feature of cross-checking input data and also provides suggestions for possible rejection reasons.
Some providers still prefer to submit paper claims. Electronic claim submission is the most efficient way of claim submission which ensures a quicker response from insurance companies. When you submit insurance electronically, it will reach the insurance company quickly and the insurance company also processes it quickly resulting in quicker payments. Some insurance companies are now not accepting paper claims anymore. Using billing software you can easily submit claims electronically. As per your claim submission requirements and medical specialty you can choose any billing software for electronic claim submission. You have to properly set up your billing software prior to submitting insurance claims.
Electronic remittance advice (ERA) is an electronic replacement for paper explanations of benefits. Electronic funds transfer (EFT) allows insurance companies to submit their payments directly to your practice’s bank account. Before you start submitting claims through billing software you have to set up ERA and EFT. It’s a process of communicating to every insurance company that you want to receive electronic explanations of benefits. By sharing your bank details, you are requesting insurance companies to directly submit payments to your bank account. Most insurance companies take at most a month’s time to process your claims, with a properly set ERA and EFT you will be able to receive payments within few weeks.
Sometimes practice owners just focus on the claim submission process and fail to emphasize on insurance follow-up process. It might happen due to a lack of accounts receivable experts in your team or providers trying to do everything on their own. Whatever might be the reason, if you fail to take comprehensive insurance follow-up, with every passed day, you are losing the chance of getting insurance payments. The insurance follow-up process cross-checks payment feedback for every single submitted claim. Claims which are denied or partially paid are reviewed for remark code, corrected, and submitted for reprocessing. It’s important to mark every single claim as either paid, partially paid, or denied and appropriate action must be taken to recover insurance payments.
Any billing team’s efficiency is measured in the number of days it took to receive insurance payments. It becomes more challenging to recover insurance payments as the number of days increases. Calculating your average AR days and sorting them by age of the claim in the AR bucket can help increase billing efficiency. To reduce accounts receivable days, you need to formulate a billing strategy for every single insurance company. You need to train your staff accordingly so that they know how to approach the unique needs of the insurance companies. AR follow-up team should be equipped with the nuances to follow up regularly and efficiently until the claims are fully settled.
Medical Billers and Coders (MBC) is a leading medical billing company providing complete revenue cycle services. We hope that the billing process shared in this article will help you in receiving quick insurance payments. You can hire our billing services if you don’t have a skilled billing team who can execute the above billing processes. As a leading medical billing company, we help our clients to receive accurate and timely insurance payments for delivered services. To know more about our billing and coding services, email us at: firstname.lastname@example.org or call us at: 888-357-3226.