To keep your practice financially healthy, you need solid processes in place, and getting claim submissions right is a big part of that. But claim denials are becoming more common. A kff.org report shows that HealthCare.gov insurers denied about 17% of in-network claims in 2021, and some insurers even denied nearly half of them. This means you need to take action to submit accurate claims regularly.
Let’s explore what a "clean" claim is and how a medical billing company can help you follow best practices to ensure successful claim submissions. But, before everything, you must know what a clean claim is:
Know what a clean claim is your physician billing process-
Always remember one thing that a clean claim includes all the critical information and you must always send it to your payer on time to ensure the perfect physician billing services.
The Department of Insurance and Financial Services (www.michigan.gov) outlines what you need for a clean claim to meet the requirements as follows:
- It identifies the health professional, facility, home care provider, or durable medical equipment provider who gave you the service. It also includes any necessary details like affiliation status and ID numbers for verification.
- Clearly identifies you and your health plan subscriber.
- It shows you the date and location where the service was provided.
- It’s a claim for services covered under your plan for someone who’s eligible.
- If needed, it proves that the service was medically necessary and right for you.
- If you needed prior authorization for a service, it includes the details to show that it was approved ahead of time.
- It identifies the service you received using a standard code system for procedures or services.
- It includes extra documents based on the services you received, as needed by your health plan
You’ll only get reimbursed for your claims if they meet the requirements and are submitted on time. But following what each payer expects can be tricky because their policies vary. Plus, payer requirements are getting more complicated, which can cause delays, rejections, reimbursement problems, and lost revenue. However, you can still implement the best physician billing solutions by implementing the tips mentioned below.
Perfect practices to ensure the perfect claim submission in your physician billing services:
Usually, when you create a claim, it goes to your RCM system, a clearinghouse, or a charge master system. This helps make sure it’s formatted correctly for your plan, sent to the right place, and set up for the best possible reimbursement. Medical billing specialists can help you follow these important steps for submitting clean claims:
1) Clearly understand your requirements:
The first step is to carefully check the claim submission guidelines and documentation requirements for the type of claim you’re filing. Submitting a clean claim relies on having all the right information and supporting documents.
2) Know about your patients’ demographics and insurance eligibility:
The truth is that the majority of claims get denied by inaccurate patient demographics and mistakes in insurance information. You must check eligibility at several stages, like when creating a patient record, adding insurance details, and scheduling appointments.
3) Accurate coding is the key:
You should always assign the accurate ICD-10 codes and CPT/HCPCS codes to ensure the right documentation procedure, Make sure you are using the codes that are supposed to be used assigned together.
NCCI edits let you use specific modifiers to show that the two codes represent different services. You should also know how to use medically unlikely edits (MUEs) to ensure accurate physician billing solutions and avoid claim denials or overpayment recoveries. Working with an experienced medical coding company can help you submit claims with the right codes.
To keep your medical practice financially healthy, having efficient processes is key, especially when it comes to claim submissions. But with denials on the rise, it's essential to submit clean, accurate claims regularly. In fact, some insurers report denying nearly half of in-network claims. This makes it more important than ever to follow best practices and ensure smooth physician billing.
By choosing physician billing outsource, you can rely on experts to help you implement these steps for better claim submission. From verifying patient details to using accurate coding and understanding payer policies, outsourcing your billing can help you avoid delays, denials, and lost revenue.
Implementing the right physician billing solutions ensures your claims are submitted correctly, helping you maintain a steady revenue flow.
Comments