How To Reduce Your Insurance Accounts Receivable And Get Claims Paid Faster 

Life insurance, health insurance, motor vehicle insurance and (strictly if applicable) malpractice insurance – all intend to help the end consumer work seamlessly, live comfortably and breathe easily.

However, repeated corrections in accounts receivable lead to much mental stress for all those associated with this process. Further, it troubles those who have to generate them. This includes the healthcare practitioner’s office, and ultimately, the patient.

Since everything boils down to the patient as the customer, we should receive the funds of the claims faster. Let us see how we can do it.

Revenue Cycle Management Chain: Right from Generation of Patient Bill to Actual Payment

The need of the hour then is to reduce the time taken for “claims processing” and ensure accounts receivable are kept at a minimum. This can be done by implementation of the following:

Greater efficiency and Lesser Wastage of Resources

The ancillary medical staff should come qualified in the processes involved. It comprises medical coding, billing and also communicating to the insurance carriers. This applies to the insurance companies too. The generation of medical bills starts right after the initial examination of the patient. And, it sums up until the actual monetary amount is credited to the healthcare provider. You can reduce this entire process of the “accounts receivables” that forms part of the complex and extremely time-sensitive key function known as Revenue Cycle Management.

Any clog in this wheel and the disadvantages, not merely monetary, can increase the magnitude.

Innovation in Available Processes

The revenue cycle for ‘Insurance Accounts Receivables’ begins with a patient walking into a caregiver’s office, clinic or hospital and ends with that caregiver receiving due compensation for his services, time and sometimes, empathy over and above the two formers. Not only the patient, but even the physician also undergoes a lot of stress.

Being up-to-date with the latest in medical billing and newer technology are the crux for ensuring faster claims and reducing Insurance Accounts Receivables.

Accepting the limitations of the Healthcare Insurance System/Healthcare Practitioner Business Model:

There is no such thing as an optimal RCM (Reverse Charge Mechanism). It needs to improve constantly upon itself.

It is not for nothing that most hospitals are ‘Not for Profit.’ That means an increase in revenue gets pooled back into the system. This should be essentially in place to help patients heal.

So, to conclude, from identification and rectification of process lacunae to creating new processes themselves, the “Kaizen” philosophy of management should work for faster claims processing.

Implementing the Principles

It is best to adapt these principles at the core.

Personal Discipline and Improved Morale

Any and every healthcare worker who puts the patient before himself leads the way for optimal processing of claims and insurance reimbursement.

Teamwork

Positive outlook in recruiting and training personnel, keeping in mind their necessities, builds teamwork with a uniquely positive cumulative effect on institutional efficiency.

Quality circles

A relatively new term, quality circles means an “optimal” chain of the management processes. Here, each resource can help in a multipronged manner to the best of its capacity. This avoids duplication altogether. For instance, the process can use the same mobile phone of a healer for anything and everything between securing patient appointments to confirming billing numbers.

Ultimately, Suggestions for More Improvement:

Optimization of resources and enhancing personnel efficiencies along with their morale can refer to as the holy grail of faster claims payment. Moreover, the revenue cycle management should be open yet transparent for everyone to understand easily.

Takeaway

The process is a financial burden on all involved. And, more so, it affects the patient who is also the health insurance consumer. You can call them the fulcrum of the healthcare business model and the start and endpoints of the monetary aspect of the insurance industry. Lastly, so also is the healthcare business owner.

If you want a faster and top-notch process following company, Medical Healthcare Solutions Inc. is the one to look for. With decades of experience in medical billing, you can have a seamless journey of medical billing.

We know you hate medical claim denials and rejections. It can be difficult for practitioners to deal with such denials. The job can be complicated, frustrating, and often very time-consuming.

Knowing how to deal with medical claim denials can save you time and improve your cash flow. Here are some basic pointers to remember:

Review all Information That You Have

Rejections are more common than you’d like to think. About 17 percent of all in-network claims were rejected in 2019 and the number was 14 percent in 2018.

To reduce your risk of medical claim denials, review all the information you have including remittance advice and explanation of benefits.

The notification sent by the insurance provider indicates whether the claim was denied, partially paid, delayed, or paid in full. 

Follow the instructions if the claim stands “contested or unclean”. Correct the issues, if any, and resubmit the claim with any missing information. 

Look for reasons why the payment was declined and make sure to follow the steps provided by the insurance company.

Get in touch with the carrier if the notification isn’t clear. Having a conversation with the carrier can help solve small issues such as an administrative error or poor submission procedures.

Waste No Time

Waste no time and submit and resubmit claims as soon as you can. Most companies and statutes put a limit on when claims can be submitted. Being too late can cause you to lose money. 

Apply Again and Again

If your resubmitted claim gets denied and the denial seems improper to you then go ahead and appeal the decision. Make sure to follow all guidelines and submit the required documents to ensure your appeal gets accepted.

Remember that the process varies from provider to provider, hence check with the carrier. Moreover, state laws also come into play. In most cases, you will have to submit an explanation of why you wish to appeal the decision and provide documents to support your claim. 

You may have to submit documents to demonstrate necessity if your claim got rejected due to a lack of “medical necessity”. Be careful about the information you provide.

All practitioners are required to meet the set obligations under the HIPAA and to only provide what’s ‘necessary’. Working with a HIPAA-compliant company like Medical Healthcare Solutions can help reduce the risk.

Filing another appeal or resubmitting your claim may do the trick. Do not give up just because you are asked to submit the claim again and again. Being persistent shows you’re serious about getting paid.

Understand How to Appeal

Since the appeals process changes from company to company, it is important that you ask questions and ensure you’re fully familiar with it. 

Being aware of the policies will put you in a favorable position to respond to medical claim denials.

Keep a Record

Keep a record of everything related to a claim including the name of the person you’ve been corresponding with. A few more things to take note of include: 

• Why the company chose to deny, partially pay, or delay the claim
• How your office followed up
• The outcome of the follow up

You might need this information in the future when you choose to appeal or file a complaint regarding medical claim denials. Moreover, these records can help face similar situations in the future.

Medical coding and billing is one of the most important aspects of any orthopedic practice, because it keeps revenue coming in, and without that the practice would quickly go under. Given its importance, it’s easy to see why there is so much emphasis placed on accurate coding and billing. Claim denials and delays will interrupt cash flow, and that will always create stress for a practice, because monthly bills and expenses have to be paid regardless of whether regular revenues are coming in or not. In order to ensure that such delays and denials are kept to an absolute minimum, here are some guidelines to follow in the preparation of medical billing claims for an orthopedic practice.

Keep abreast of all updates 

Every year there are changes to the Current Procedural Terminology (CPT) code set, and these are ignored at your peril. If your coding and billing is performed in-house, you need to be aware of all changes issued, so you can be sure to use any appropriate new codes. In any given year, there are generally several hundred updates applied to the code set, and your in-house personnel need to be educated about these, whatever they may be.

Avoid the most common reasons for denial 

In order to avoid the most common reasons for denial of a claim, you have to be aware of what those common reasons are. Duplicate claims and services are probably the single biggest reason that claims are denied by a carrier, so each claim should be scrutinized so as to avoid this. It’s important to be familiar with the fee schedule and stay within its guidelines. Make sure that patient information is correct when it’s gathered, and be diligent about verifying insurance information, because these go hand-in-hand with denials when anything is amiss.

Understand how ICD-10 changes have affected orthopedic billing codes 

Orthopedic coding and billing may have been more significantly impacted than any other area of medical practice by the recent ICD-10 updates. For one thing, laterality is fully addressed in ICD-10, whereas it was nowhere to be found in ICD-9. That means physicians must document right, left, and bilateral for all fractures and joint issues. In addition, it will now be necessary to specify the actual site on the body where service is delivered, rather than simply documenting spondylosis or spinal stenosis. Payers will require that a physician submitting a claim document exactly where injuries have occurred and what kind of treatment was delivered. It will also be necessary to identify the type of visit that a patient makes to your office, i.e. an initial consultation, a follow-up procedure, or a continuation visit.

Consider outsourcing 

Depending on the size of your orthopedic practice, it may be highly advantageous for you to consider outsourcing your coding and billing processes. One of the first advantages you should gain is fewer delays and denials of your submitted claims. Billing companies recognize that their reputation depends on accuracy and reliability, so they go to great lengths to make sure their team of coders are well-versed in all the current medical codes, and that they stay abreast of current developments and changes. Any company which doesn’t adhere to high standards of accuracy and reliability simply won’t be in business for very long.

When you outsource your coding and billing operation, you’ll relieve yourself of the necessity of hiring trained staff members to perform that function in-house, so you are likely to save money on monthly expenses due to the lower payroll costs. You will probably also notice an increase in profitability and a more consistent cash flow, because you have fewer denials and delays, and this can be very important in terms of keeping your orthopedic practice running smoothly. Outsourcing may not be right for every single orthopedic practice, but it has proven to be very helpful and very effective for a great many physicians already, and it has removed a great deal of stress from the coding and billing function. It might well be the best way for you to handle all the intricacies and complexities of orthopedic billing.

Gastroenterologists provide both surgical and medical services, and that calls for a fairly broad range of billing codes to be used when it comes time make a claim for reimbursement. In gastroenterology, all reimbursement must be based on the principle of Relative Valve Units (RVU’s), which are assigned to every possible service which might be provided to a patient. These services are founded on three individual factors, including practice expense, malpractice cost, and physician work value.

The national physician fee schedule is determined by adding all three of these factors together and then multiplying by a specific conversion factor which is decided by the Centers for Medicare and Medicaid Services (CMS). Whenever claims are submitted, there must be a clear medical necessity demonstrated, otherwise there’s a good chance that a claim will be denied, or at least deferred pending further investigation. In terms of incoming revenue, any deferred or delayed claim is almost the same as a denied claim, since it results in some indefinite period of non-reimbursement.

There are four essential services which gastroenterologists perform routinely, and must choose the correct billing codes for when they wish to be reimbursed for services provided. These four areas are: evaluation and management services (E&M), endoscopy and procedural billing, diagnostic studies, and diagnosis codes. Making a mistake with the billing and coding in any of these areas will very likely result in some kind of delay in being reimbursed, or in an outright claim denial.

Evaluation and management services 

E&M visits are often extremely important, given that they provide the foundation for any medical necessity regarding additional procedures or diagnostic services. These can be crucial for successful treatment of the patient, and that makes them just as important as the actual procedures, which are often deemed more important to a practice, since they generate the most amount of income. For E&M services, there are three criteria which must be met in order to validate an initial patient visit: patient history, the examination, and the treatment plan. 

There are five levels of service for such initial office visits, and there are also three levels for inpatient visits. These levels must all be accurately coded and billed for, and it happens frequently enough that an un-schooled clerk will assign a guessed-at level rather than the most appropriate one. This may go unnoticed for a time, but if an audit ever becomes a reality, these guesses will be discovered and it will result in claim denials or some kind of reconciliation on past claims.

Endoscopy and procedural billing 

Before you can make any kind of claim in this area, it will be necessary to justify medical necessity. Documentation must include the location of any abnormalities or lesions, method of treatment, and the reason for that method of treatment. Any special equipment used during the procedure must be fully documented in the endoscopy report, and this requires close communication between the physician and the billing staff. Ultimately, the physician is responsible for the submission of accurate claims, so it behooves the medical professional to have the billing staff well trained in how to supply appropriate and required documentation, as well as the correct medical billing codes for every possible procedure.

Diagnostic studies 

As always, medical necessity must be demonstrated in order to submit a claim for any kind of diagnostic testing. Abnormal lab tests, unusual symptoms, and signs of illness do warrant the need for continued examination, and these are generally the most important factors signaling the need for further diagnostic testing. It will be necessary to clearly indicate the results of any diagnostic testing, and for any procedures which were necessary. A plan or recommendation for treatment must also be included and indicated by the appropriate billing codes when submitting a claim.

Diagnosis codes 

Codes for diagnosis come directly from ICD-10-CM, and the assignment of these codes is the next most important step after a patient visit, a diagnostic study, or a procedure. These billing codes provide justification for medical necessity of services provided, so it is crucial that the correct codes are used. Since there are nearly 72,000 codes which might be used in this area, it is essential for office personnel to be properly trained in the correct usage of the codes. Getting reimbursed for all services provided requires a good amount of education and training for all staff members, in addition to close communication between physician and office people.