Don’t Get Stuck With the Bill: Choosing the Right Claim Strategy for Your Practice

When you’re getting paid for the care you provide, how you decide to manage insurance claims can change the game. There are two primary ways of managing insurance claims for treatment or care – cashless and reimbursement – and we’ll help you end the endless debate on cashless vs reimbursement claims.

Cashless vs Reimbursement Claims: Understanding Healthcare Costs

First, we should cover how much treatment costs. In the USA, healthcare costs can vary quite a lot depending on:

•  Treatment type: Some medical procedures cost more than others.
• Facility type: Hospitals and clinics will charge various amounts.
• The patient’s insurance: Different health insurance plans in the USA cover different things, and some have large out-of-pocket costs.

Knowing how these factors play into the total cost will help you make smarter choices about claim strategies.

Cashless Claims: The Convenient Option

Cashless claims are of great value to policyholders, and their process is much more effortless. Here are the key benefits:

• Less Hassle for Patients: There is no need for patients to pay out-of-pocket and then wait for reimbursement. This would eliminate much of the financial strain and administrative burden sometimes associated with traditional claims.
• Direct Payment to Health Providers: The insurance company directly pays the health provider, hence relieving the patient from the financial burden and giving him the liberty to focus on getting well again.
• Immediate Access to Health Services: The patient can access healthcare services immediately without waiting for necessary treatment, as they do not need to arrange funds for upfront payments.

Reimbursement Claims: More Flexibility

A reimbursement claim refers to a situation where the patient pays the insurance company and is reimbursed at a later date. In this case, claiming fees has the following advantages:

• More freedom to choose providers: One has the freedom of choice in selecting the healthcare provider best suited for them. If one prefers a specific clinic over another, they are free to choose the clinic of their choice.
• Potential for higher fees: Since one is not bound to an insurance company, they can charge their fees.
• Specialized Care Access: Patients can receive treatment from providers or facilities not in their network, which may offer specialized or higher-end medical care.

Cashless vs Reimbursement Claims: Making the Choice

So if we go further on this debate of cashless vs reimbursement claims, we land on the question of what claim strategy should you go for. Here are some things to consider:

• Your patient population: Do they have insurance that offers cashless benefits? Are they sensitive to out-of-pocket costs?
• Your financial goals: Do you need fast payments or you can wait for them?
• Your network participation: Are you a part of insurance networks, or do you want to be?

Here’s a quick comparison to help you decide:

A Few Tips for Success

Choosing the right side in the battle of cashless vs reimbursement claims can be a difficult task. Regardless of which side you choose, here are some tips for ensuring everything goes smoothly:

• Get to know insurance plans: Understand what different plans cover and how much they pay.
• Verify patient benefits: Check that your patients are covered for the services you’ve decided to provide them with.
• Communicate clearly: Let your patient know upfront how the billing process works, down to what they have to pay out of pocket and what the insurance company will cover.

Cashless vs Reimbursement Claims: Making the Right Call

When it comes to the battle of cashless vs reimbursement claims, choosing the right choice for your medical practice depends on your business goals and personal preferences. consider the aspects we’ve discussed, and don’t hesitate to consult with insurance companies or billing professionals to guide you. With the right strategy in place, you’ll be able to streamline your billing process, be paid faster, and focus more on what you do best — providing care to your patients.

Struggling with claims? Don’t get stuck with the bill! Capline’s RCM services streamline your billing, maximize reimbursements, and let you focus on patient care. Contact us today for a free consultation.