5 Best Practices for Successful Medical Claims Processing

Do you want to improve your ROI and maximize your productivity, while streamlining operations? If yes, read the following five best practices for successful medical claims processing.

The AMA (American Medical Association) recently stated that the rise in claims processing errors is causing unnecessary costs for the healthcare industry. The complexity in medical claims processing makes it difficult for medical insurers to find a way of reducing claims processing expenses. Usually the unwanted expenses associated with claims processing is related to claim delays and denials. The several manual and complex steps involved in the claims system further complicates the situation.

How can health insurance companies improve their ROI, reduce the steps involved in claims processing and streamline operations? The impossible can be possible by adhering to some of the below best practices. From improving your accuracy and productivity to preventing operational issues and errors, here is how you can make a success out of medical claims processing.

  1. Opt to only submit electronic claims

    Submitting your medical claims electronically can help you save on paperwork and reduce errors, not to mention the lesser time it will take to help you submit the claims. Once a claim gets processed, you can view its status online, manage your profile and verify the eligibility of members. With everything done at the click of a button, you can settle your claims within an hour. A steep increase in cash flow, lack of unnecessary denials and reduction in cost are the other benefits of submitting your claims online.

  2. Check for inaccurate / inadequate information

    Delays in claim processing are usually due to errors. Rejections could happen for inaccurate insurance IDs, CPT codes, address, patient names, date of birth or ICD codes. Rejected claims will have to be corrected and resubmitted. How do you submit clean claims, without any errors? The answer is simple. If the information is difficult to read or does not look right, go back and refer the original documents like the patient insurance card. Make sure that each and every patient is questioned for any changes in their patient/insurance information. By keeping patient information up-to-date, errors can be identified and resolved quickly, helping you stay within the time limits required for submitting a claim.

  3. Collect deductibles, co-payments and patient balances

    If payments are not collected before the treatment starts, patients could walk out without paying. Make sure that copays are collected. A patient’s account should be reviewed so that prior balances can be collected. In case of a deductible, a small deposit can be collected from the patient and the balance amount can be settled after the treatment. If a patient has already met their deductible, you could mail a refund check instead of following up and writing off uncollectable balances. This would be less expensive.

  4. Send invoices on time

    Make sure to send out patient invoices as soon as the EOB is posted. The invoice should contain details of each service performed, the date of the service, the payments collected, the insurance reimbursement received etc. Ensure that the invoice is easy to understand and clear to read. You could accelerate payment by accepting credit card payments. This will not only reduce costs, but it will be saving your patients the trouble of writing and mailing a check.

  5. Make use of analytics to get an edge

    You can use analytics to improve your performance and comply with regulations at the same time. In-depth analytics can show you where you need to make improvements, how to bridge process gaps and how to improve your services. There are several insurance companies who are not able to find out the source of their errors and problems. Analytics can help you avoid errors and manage complex claims efficiently. Performance variability can be removed, operating costs can be reduced and the people with the best skills can be deployed in the right areas, all with the help of analytics.

The above best practices can improve your efficiency and streamline your processes. Did you know that your medical insurance company can overcome the challenges of processing speed, volume, accuracy, rising costs or regulatory compliance by simply outsourcing? Find out more about outsourcing medical claims processing.

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