Steps to Follow to Get Reimbursement for Your Practice


Denied insurance claims—the healthcare revenue negating claims. The common occurrence of such denials is too unfortunate for the current scenario of the healthcare and medical billing service.

According to medical insurance experts “In most of the cases, the claims get denied due to the fact that there are simple errors in the coding process, while few errors happen during the time of claim submissions”.

This has resulted in many insurance companies currently denying settling claims during the first submission or a claim is lost during submission.

In such cases the medical billing team has to resubmit the claim or even go through the entire documentation process again looking at different flaws which had escaped their eyes. The revenue management process can be outsourced or have an in-house team of expert coders and billers.

Now getting your claim settled from issuers requires a tedious task of continuous follow-up. As the timeline of the claim settlement increases the hospitals can follow up with the insurance company and even get legal help to settle the claim.

Following are the points to look for before you appeal for your claim settlement

Preparing an appeal

If you are preparing for an appeal create an outline for the argument for which the claim should be honored by the insurer. Read all the policies mentioned in the claim settlement bond. Read the percentage of revenue which will be paid by the insurance company and then by the patient. One of the major reasons for the denials is that the physician’s overcharge than the amount mentioned to settle the claim.

According to billing experts, the insurance companies are very precise when the patient wants to buy the insurance. They only cover certain specific amount to be paid in cases of certain diseases which occur. The doctor’s office and the patient make a mistake of overcharging and claim goes into a cycle of resubmission. Now, this makes the process extremely complex for doctor’s office for settling the claim.

Navigating through the appeals process

One of the major reasons the claims are denied are due to simple fact they should maintain a simple and precise tone which the insurers can understand. Anything which doesn’t comply with our level of settlement we just dump them or provide them with an EOB. We are always processed to find a solution for claim denials.

When you are appealing for a denied claim one thing to keep in mind is to have cool and calm mind, while reading through the EOB. Interpret the words and the meaning behind them in accurate way. It’s important to remain cool and calm with the billing process.

Here are some tips to maximize the chances of billing success.

Stay organized

Keep every scrap of paper related to a patient with you. It’s important when it comes to documentation for medical billing. Whenever insurance companies gets your claims it might conduct a surprise audit of your total claims approved by a federal government. This might even require the documents related to the first appointment date and time. Your every consulting word should be documented by the date and time provided with simple token to help you with simple organization process.


Now this might take time for your revenue team to figure out but each insurance company needs different timeline to settle claim and for each claim different amount of communication. Now most insurance company contact through agents who represent the first line of contact. Usually when the claim is submitted over and over to same insurance company it’s always better that an insurance agent is fixed for you, which will increase your time efficiency.

How can medical billing process be organized and implemented by physician without any out-of-act effort? An outsource team of expert coders and billers will be implementing all the efforts required to get your claims settled. As a physician you only have to provide all the documents related to the patients nursing. A team of revenue managers and AR callers will provide you with end to end revenue management.

This entry was posted in Medical Billing, Medical Coding, Practice Administration, Practice Management, Revenue Cycle Management (RCM), Why Outsource Medical Billing Services and tagged , , , , , , . Bookmark the permalink.


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