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.

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4 Common Mistakes That Cause Claim Denials

Is your medical practice’s denial rate above 4%? If yes, then its time you started looking closely at your processes. Without you even realizing it, things like input oversights, timing issues and manual errors could be causing denials. Here are some common reasons for your denials. Read on to find out how you can tighten your billing approach and reduce your denial rate at the same time.

1. Illegible claims

Though most payers now accept electronic claims, there may be some who would still use paper and opt for manual submissions. It is not uncommon for printed claims to be illegible and messy. This can generate problems for payers who have to scans such claims into their systems. At your end, you can ensure that your billers pay more attention to such claims and make sure of their readability before sending them to the payers.

2. Vague claims

Coding a claim to the highest level of specificity is the best way to minimize your denials. Make sure that any diagnosis is not vague and is coded to the highest level (maximum number of digits for the code that is being used). For example, if you have a four digit code that requires five numbers to be accepted, make sure that you have included all the five digits. It is also a good idea to provide your billers with appropriate education on coding.

3. Claims with missing information

If there is data missing from your claims, then you could again get a denial. Payers can notice omissions and deny claims based on missing information (the date of onset, the date of the accident or the date of the medical emergency). Make sure that all the required areas on your claim forms are filled. Next, ask your billers to check out the commonly missed fields and rectify the errors, before the claim is sent. Continue reading