Steps required to be assured of the entire healthcare claims are processed before the end of the month

The ultimate objective of submitting claims to insurance providers is to get payment of the claim. Medical billing plays an important role in the financial success rate of healthcare organizations, and claim denials can affect the processing of claims. For better settlements of claims before the end of the month, a medical center or healthcare provider needs to check the reason for the denials and submit the claims at the right time. Minimizing the claims denials may automatically result in the increased cash flow. 

Here are the tips that can help in avoiding and managing the claim denials.

If an insurance company denies a claim then it can add two or more weeks delay in processing the final settlement of the claim. For settling all claims before the month’s end, it is important to minimize denials in the first place. If still the claim is denied due to any reason then quickly check, find, correct errors and resubmit the claim. This way you can speed up the payments.

Here are a ways that can significantly help in preventing denials and can get the final settlement of claim done before the end of the month:

Train your staff:

Making good communication internally and externally is the key to the success of any healthcare industry. Every staff member including the medical staff and backend office needs to understand their roles and responsibilities for ensuring the optimal financial outcomes and satisfaction of patients. It is also important that your staff is well trained about what services the healthcare organization is providing and what is not covered by the patient’s insurance plan. Additionally, the frontline staff needs to check the co-pays and deductibles of patients with the right coding for the services provided to the patient. Missing information can result in a wrong or inaccurate claim thereby resulting in a denied claim or delayed payment. It is quite evident that good communication is the key to educating and updating certifications so that every member of your team has information about the latest changes in the insurance policy and healthcare services.

Know about the patients:

Many health care providers accept different kinds of insurance plans with each plan containing a variation that is allowed and can be reimbursed. This makes it quite difficult to understand the process so making a close relationship with insurance providers can make it easier to be updated as per the current and evolving rules of the healthcare industry like prior authorizations, referrals, and many more. Understanding all these points can make it easier for the healthcare provider to submit the claims easily with recently added patient information and get the payment before the month-end.

Checking the insurance of patients before providing the service:

Checking the eligibility and verifying the insurance can prevent the claims denials or write-offs. Never imagine that a patient who is covered by any insurance plan hasn’t changed his insurance due to turning 65. He could be beginning Medicare, going on and off Medicaid, undergoing a job change or loss, and could have various other reasons that can affect his coverage. It is also quite possible that the same patient may have a different group or member ID number, coverage, co-pay from passing year to year. Thus, it is best to check for all the details of patient insurance before every single visit of the patient.

Try to include automated solutions in your medical center:

It’s natural to believe that humans tend to make errors. The more the number of errors the greater the number of denials a medical center will have to deal with. It is best to use software that can self-code precisely without making any flaws, and can increase reimbursement rates. If followed rightly, these claims will be processed at the first attempt, leading to revenue growth before the month-end.

Get learning from previous claims denials:

Try to maintain proper data including all the information about all insurance types and their payer IDs. Well-Organized data can reduce the chances of rejection in the future and in turn can increase the profits of health care organizations. At the same time, establishing a track record can help in analyzing the trends in the payer’s rejections and will lead to the successful processing of claims. It will also make it easier to learn where the errors are and how to fix them immediately.