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How Can You Improve the Quality of Medical Claims?

How Can You Improve the Quality of Medical Claims?

Your healthcare practice cash flow is driven, impacted, and influenced by a multitude of several factors. In any medical practice, inefficiencies in revenue cycle management can be dangerous. With the decline in reimbursement rates and the move to value-based care. it’s even more crucial to adopt an action plan of constant improvement. Because it’s important for the financial well-being of any healthcare facility. 

However, efficient billing is an important part of achieving those financial targets, but it doesn’t often achieve automatically. As patients take on more financial responsibility for their care, many healthcare practitioners still rely on inefficient or outdated billing procedures. As a result, they failed to effectively collect from patients which led to bad debt and outstanding payments. 

In order to succeed, medical practices must continually look for more innovative and efficient ways. To improve the quality of medical claims, deliver quality care, lower costs, and improve health outcomes, and patient satisfaction. 

However, improving billing efficiency and cutting costs at a healthcare facility is easy to say but challenging to achieve. Without an efficient billing process, healthcare practitioners might find it challenging to maintain high levels of clean claims, or manage their billing effectively in-house. 

That’s why healthcare service providers need to consider the following solutions to stabilize and increase their healthcare practice revenue in the new year. Doing so may not only help sustain healthcare practice cash flow but optimize it dramatically. 

Here are five solutions that can help medical facilities optimize their quality of medical claims, improve medical billing efficiency, and patient experience and ensure that you get reimbursed fast. 

Submit Claim Electronically: Getting paid timely and accurately is a key concern for many healthcare service providers. However, electronic claim submission is one solution healthcare professionals are increasingly using to facilitate the claim reimbursement process. 

It will help to improve their cash flow and help to optimize their billing operations. However, filing a claim electronically comes with a number of benefits;

  • When your medical claim is processed more quickly it will result in faster reimbursements.
  • You can also verify or track the status of submitted claims at any time.
  • Improve accuracy and cut down on claim denials by minimizing errors.
  • Fewer lost.
  • Simplify record keeping. 
  • Freeing up your administrative team’s time to perform other key operations.
  • Prevent the need to fill out and store paper claims. 
  • It will help to streamline your billing procedures.
  • Minimize the clerical time and cost of mailing, processing, resubmitting, and tracking the status of paper claims.

Scrub Claims to Reduce Denials: Make sure that all the information that your front-end staff gathers from patients is accurate and complete. Because a tiny error in patient demographic information (name, date of birth, phone number), policy ID number, insurance eligibility, coverage, and medical codes can result in claim denials. 

However, there are different claim scrubbing tools available in the healthcare market. By utilizing these tools you can easily catch and rectify common billing mistakes/errors. And ensure a 100% clean claim submission process. 

It’s essentially a way of auditing medical claims before they are submitted to the insurance company. So, medical claims can get paid fast, instead of waiting weeks for denials and having to resubmit them for payments. 

4 key benefits of utilizing claim scribing tools as compared to claims not scrubbed.

  • Improve first-time pass rate.
  • Validate files for every insurance company. 
  • Ensure HIPAA compliance for all your medical claims.
  • Access extensive databases to properly catch errors and problems on claims.

Timely Delivery of Claims: Maintain a regular and consistent claim submission schedule. If you submit a medical claim as soon as possible, making it easier for medical professionals to receive their payments and for payers to process claims in a timely manner.

On the other hand, if you file a medical claim once a week it will result in a bigger blockage to work through. It will also sometimes cause higher chances of discrepancies and mistakes.

Keep in mind that every insurance provider has its own standard filing deadlines. If you miss a deadline, the claim will usually be denied. You should also include a workflow to alert billing staff when a medical claim approaches the deadline. 

One of the best strategies to reduce claim denials is- to hold a competition to see who can submit the most timely and accurate claims each month, quarter, and year. It will help to improve your business productivity and overall profitability.

Monitor, Analyze and Audit your Medical Claim: What is the best solution to make sure a healthcare practice is getting paid for all of the care services they provide? By establishing a reporting process that tracks each and every healthcare service provided to a patient.

If your medical practice denial rate is between 5% or less then it’s really good for the financial health of your business. But, if it exceeds over 5% then you need to establish a strategic action plan in place to prevent denials. 

You should learn from your mistakes and identify why denials are happening. Some of the common reasons for claim denials include errors in patient data, wrong medical coding, insufficient documentation, etc. So, if you track your medical denials on a daily basis, you will be able to see the loopholes in your billing process more clearly. 

You should also conduct staff audits to ensure appropriate coding and documentation. However, if you uncover loopholes in your billing process then develop a process in place to strengthen your business and finance operations.

Acquire the Help of a Billing Specialist: Many healthcare service providers feel comfortable outsourcing their medical billing services to a reliable medical billing company. One reason for doing so is that they can access a qualified and professional billing team, whenever they want immediate support. 

The billing expert always stays updated with current regulations of CPT & ICD-10 codes and insurance guidelines. 

They have a strategic action plan to catch the problematic cause and rectify them before any damage happens. They also help you to stay compliant with HIPAA compliance standards and ensure the confidentiality of patients’ personal data significantly. 

Billing experts have advanced billing tools and technology-driven capabilities that help them to improve the quality of medical claims. You can gain the following benefits when outsourcing your medical billing services to experts.

  • Automate the entire medical billing cycle.
  • Implement a clear collection upfront procedure.
  • Update and maintain data accuracy.
  • Optimize revenue cycle management.
  • Enhance quality control.
  • Track claim denials.
  • Follow-up on delinquent claims.
  • Efficient reporting.
  • Increase cash flow.

If it’s difficult for you to manage billing procedures in-house. And your healthcare practice faces constant revenue leakage problems. Then it’s time to acquire the help of a medical billing specialist

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