Healthcare organizations are keeping their focus on offering the best and most possible patient care. However, it is significant for every hospital and medical practitioner to maintain prominent processes and policies to leverage financial well-being. This is where success with claim submission plays a critical role. But, according to an analysis, healthcare facilities and practices are now witnessing an increase in denial rates, with average claims denial rates reaching 10% and more, which has increased more than 20% in the last five years. Outsourcing revenue cycle management to a competent medical coding and billing service provider can help healthcare practitioners maintain balanced finances and patient care. Experts can help you develop robust strategies to attain success with claim submission.
RCM involves balancing administrative and clinical claims processing, payment, and revenue generation tasks. This also helps providers collect payment for services rendered. Claim submission success is all about submitting clean claims to insurance companies. Providers must have explicit knowledge of what a clean claim means.
What is a clean claim?
A clean claim is a claim that must be submitted to the payer within the decided and given timeframe and contains all of the mandatory information in the appropriate format. Clean claims must abide by the expectations and policies of the payer. Certain things make a clam clean. Claims that meet the framed requirements and are submitted on time will be paid. However, staying aligned with the expectations and policies of the payer is not easy. These expectations are different for each payer. Furthermore, payer requirements are becoming highly complicated. This results in denials, rejections, claims reimbursement issues and lost revenue.
5 ways to gain success with your claims submission
Inspecting patient demographics and insurance eligibility before submitting a claim is crucial to reduce the risk of claim rejections. Inaccurate or missing patient information becomes a common reason for claims denial. Patient demographics should be frequently checked during every visit, while insurance eligibility should be finalized prior to the first visit and all regular visits.
This is an important step to eradicate rejections. The claims scrubbing process includes using high-end software to review medical claims prior to submitting them to insurance payers. Claims scrubbing software can target and correct errors or potential concerns that could create a reason for claim rejections, denials, and delays.
Correct coding can enhance the possibilities of an approved claim. Collaborating with an experienced medical coding partner is the finest way to state that claims are submitted with the proper codes for medical diagnoses and services provided to patients. Incorrect or incomplete codes can be the reason for claim rejections or denials and loss of revenue.
Healthcare providers must operate to adjust, appeal, or reopen denied claims. But this can only be done if there is a valid reason. To minimize the number of claim denials, healthcare organizations should first dig out the root causes, sort the appeals process, and integrate efficient preventive measures.
The most critical impact on a healthcare provider's revenue can result from credentialing and enrollment rejections. Inaccuracies in understanding how providers are credentialed with payers can lead to improper enrollment with the clearinghouse, preventing claims to payers within the minimum filing deadlines.
They are credentialing evidence that a care provider has all the required qualifications to treat patients, including education documents, specializations, and additional training.