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December 17, 2021

4 Smart Tips to Streamline and Improve Medical Claims Processing Services

A claim processing journey starts right from a patient making an appointment to the final bill payment. The journey is quite lengthy and has multiple steps that are complicated to perform. Such multiplicity and complexity heighten the chance of process errors. Complexity prolongs the time taken to settle a single claim particularly when a billing executive is dealing with a complicated patient case.

Automation is no doubt a possible solution to such claim management-related challenges. But a process wide automation will take time. Enterprises will need to break free from their inhibitions regarding data security to embrace automation. However, a quick solution for claim management challenges is possible. Here’s a look at 4simple but smart tips that can streamline and bring visible improvement in medical claims processing services:

Communication to Foster Clarity

Claim processing executives must maintain an open and transparent communication with patients. They must proactively educate new patients about their responsibility to pay for medical services they have availed. A smart way of doing it is including this education in the paperwork that a patient fills while checking into a hospital.

Signages at reception area communicating about payment policies can also educate a patient upfront about their payment responsibility.Medical claim processing executives must obtain billing information from patients and get a copy of their insurance coverage on the very first day. This is the first steppingstone towards a timely payment collection.

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Insurance Verification from the Get-go

This is undoubtedly the most important step to take to ensure medical claim reimbursement. Claim processing executives must verify insurance coverage and demographic details for new as well as returning patients. Why returning patients? Because there are chances that the patient has changed insurance carrier or has a new coverage from their spouse.

There’s also a possibility of patients upgrading their insurance coverages to expensive plans with lower deductibles or cheaper plans with more out of pocket expenses. Executives must match policy detail numbers and subscriber information furnished by patients to that of insurance carrier’s records.

Tracing Denied Claim Management Weak Spots

Insufficient claim support documentation, improperly credentialed physicians, using medical codes that are not covered by payers, are some of the common reasons of claims being denied.One way to avoid using inappropriate codes is to send chart notes along with billing codes to the medical billing department daily.

In case of a serial denial claims, executives must reassess their coding protocols and the process they use to verify a patient’s insurance coverage.

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Delinquent Claims Follow Up

Billing mistakes, inadequate communication between patients and their insurance carriers, and process lag observed in the billing and coding team are some of the factors that spike the number of delinquent claims. Medical claims processing executives must set in motion processes that enable faster claim processing in an efficient way. It is absolutely imperative to iron out communication creases to bind together all the stakeholders in the entire claim process flow. This will help in a better introspection into process flaws in different teams and address those in no time.

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Parting Note

Upending the existing staff’s skill and updating infrastructure can improve medical claims process but it will invite additional expense and time. Most importantly, this will prevent frontend staffs to give undivided attention to their core medical duties. In such cases, outsourcing the claim administration back-office tasks is the best bet. However, enterprises must make careful choices. Adoption of automation, regulatory compliance, frequency of claim audits, synergized process flow are some of the factors that define a qualified third-party medical claim processing service provider.

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