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Tips for Navigating Insurance in Medical Billing

Medical Billing
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Medical Billing

Healthcare providers require a strong revenue cycle to perform the expensive work of offering healthcare services. Verifying that your practice receives payment for the services it has provided can be complicated. The challenge is that insurance companies reimburse the healthcare providers after the patients have already received the services. Insurance companies may also reject or deny claims for varying reasons, such as medical billing errors.

Medical Billing Tip for Navigating the Insurance

Verify the Information of Your Patients

When filing medical claims, you should record both the basic information of your patient and how you treated them. Giving incorrect or incomplete basic details in the UB-O4 and HCFA forms is mostly a cause of claim rejection. To make sure you provide clean, accurate patient information on every claim, take these steps:

Find Out the Contact Info and Demographics of Every Patient

How you seek information from your patients can make a huge difference. If you ask a customer whether their information is up to date, they may not be sure how current their data is. Ask them specific questions such as: “Is x still your address?” This will help the customer to identify errors in their records.

Validate the Health Insurance of the Patient

Patients might not be sure whether their insurance information is outdated. Before admitting a customer, ask them for their policy number, insurance ID, and group number if necessary. Contact the insurer to verify the coverage and benefits of the patient.

Have Clear Payment Terms

The insurance may agree to cover the treatment of a patient with a certain amount of copayment. 
You want the patient to pay the amount sooner and not later. Here are steps to make this happen:

•    State the amount the patient owes and how and when they should pay
•    Keep in touch with the patients if they can’t afford to pay the amount during the appointment
•    Keep the patient informed on how you are relating to their insurance company. If the insurance denies part or the entire claim, the patient should seek an explanation from the insurance company as to why the claim was declined
•    Know how to handle non-paying patients

Verify Your Coding

Incorrect medical coding can be a cause of claim rejection. Medial services codes contain several digits, which makes it easy to code a claim wrongly. Insurance companies use automated programs to check and verify codes. The program will treat any mismatches as errors and ask you to correct them.

Know How You Will Deal with Denied or Rejected Claims

Denials and rejections of claims will occur, even if you work hard to check your claims before filing. To handle rejected claims, check the errors the insurer has stated, correct them, and then submit the claim. For denied claims, the insurers should issue you and the client EOBs saying why they rejected the claim. 

You Can Get Professional Help with Your Medical Billing

Balancing between offering medical services and pursuing the insurance company for claim payment can be challenging. The experts have a medical software platform to help you streamline your medical billing tasks. Outsourcing your medical billing includes entrusting your whole billing cycle to full-time external experts of coders and medical billers instead of your in-house office staff. This can help you prevent errors or denials for your billing claims

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