Top Five Tips To Improve Medical Claims Reimbursements

Each and every practice aims to not just offer top-level patient care but also increase their medical claims reimbursements. One of the primary reasons for loss of revenues across entire spectrums of practices are the denied claims, and will likely maximize once the new and more complex ICD-10 codes are completely implemented. One of the best defenses against denied claims is having a trained and experienced billing staff; although, there are other certain ways practices can lose revenue. Here are top five errors or mistakes that can cost you and solution about what to do with them:

Problem #1: Due to Inadequate Documentation
Because of the inadequate documentation proving medical necessity, your claims are being denied; this is particularly significant for practices with a high number of Medicare patients. Pre-authorization is required by the other companies from insurance company or a referral from a primary care physician (CPC).

Solution: Document every single Procedure
Document entire procedures thoroughly and accurately by healthcare providers, diagnoses and other findings for per patient. Incorrect data will cause a claim to be denied, and precious time lost filing a corrected claim.

Be definite to have any required authorizations and referrals on file at the time of the sufferer’s visit for reimbursement.

Problem#2: Errors in Filling Claims to Insurances
Because of mistakes by your billing and coding staff whose training and experience is inadequate to rightly code and bill clean claims, your claims have been repeatedly denied.

Solution: Keep your Billing Staff Up-to-Date
It has become more problematic as the new ICD-10 codes go into effect. A refresher or retraining session might be in order for your coders and billers whose knowledge is inadequate to send out clean claims. To update staff on the latest billing and coding changes as they occur, your office should have regularly-scheduled training meetings to ensure that billing staff all have the similar levels of training and approach to correct billing and coding information.

For further data about ICD-10 training programs, Claims Med, a leader in medical billing, coding and documentation services, gives ICD-10 training webinars to bring your staff up to date with the new changes in the field of coding. Maximizing your practice’s billing precision will result in an increment in your reimbursement rate.

Problem #3: Submitting Duplicate or Fake Claims
Duplicate or fake claims are less common these days. The credit goes to more practices utilizing electronic billing but errors still happen, like entering the same date or duplicate charges on the similar claim form.

Solution: Integrate a Quality Control Layer in your Billing
 Entire claims should be “proofread” and analyzed by the billing and coding staff before they go out the door or click and send. Providers should make sure that billing and coding staff have adequate time and manpower to process claims rightly.

Problem #4: Filling the claim with appropriate Guidelines
Few expenses incurred by some healthcare providers for expenses in the procedure of diagnosing and treating sufferers might be complex to file rightly for reimbursement, especially with when treating Medicare and Medicaid sufferers.

Solution: New rules have already been induced by CMS
New rules have been proposed by Centers for Medicare and Medicaid (CMS) that can positively affect 2014 reimbursement for certain providers. Few of these rules, for instance, involve proposals in maximizing payment for ASCs and HOPDs, based on the kind of services offered.

Problem #5: Continuous Education of Billing Staff
Billing and coding staff experience complications in keeping up with the claims workload however they are much trained or experienced staff while maintaining a high degree of precision in processing claims.

Solution: Meet the Compliance and Make your Staff Educated
This is a usual issue in several busy practices, particularly with over-worked staff and will likely worsen with the execution of ICD-10. In this case, working with an experienced vendor, such as Claims Med can give accurate prompt EMR Services as well as promise complete compliance with the latest regulations, thus ensuring larger rates of reimbursement and empowering revenues. Call us at 713-893-4773 today.