In an ideal world, medical billing would always go as planned. However, we all know that medical billing is a complex and complicated process, and all too often things do not go the way you would like them to. This can increase the cost and time of the claim’s filing process. There are multiple steps to take between the initial claim submission and final payment posting. In order to ensure your medical billing process is flawless, you need to first understand what additional steps might need to be taken when things don't go according to plan, including:
Your office should be following up on a claim as soon as 7-10 days after the initial claim has been submitted if you have not heard a response from the insurance company. Taking quick action to follow up on claims will have two results. First, it will reduce your accounts receivable timing. Secondly, it will increase your cash flow. Neglecting to follow up on a claim can end up costing your practice time and money in the long run, so be sure to get ahead of the curve.
When a claim is originally submitted with mistakes, it needs to be resubmitted with corrections. In some cases, the claim is sent back from the insurance company with a request for additional information. Regardless of the reason, you will need to resubmit the claim with the correct and complete information as required by the insurance payer. Once these corrections have been made and the claim has been resubmitted, the claim should be billed as an original or corrected claim depending on the insurance payer's billing guidelines. You will need to do additional research to determine how the insurance payer requires you to label this resubmitted claim.
Sometimes a claim is denied or the insurance company has incorrectly or only partially credited the claim, and your office will need to decide whether or not an appeal is necessary or appropriate. Examine the reason for denial to determine whether or not to file an appeal and to determine how likely it is that your appeal will be accepted. If you believe that the insurance payer wrongfully denied your claim, then you should absolutely make an appeal to change their decision. If it has been denied due to simple registration errors, then you'll know that something went wrong in the initial procedural process. In order to avoid a simple registration error, it is necessary to have a system in place to recognize the need for prior authorization and patient eligibility for services. When done correctly, appealing medical claims can be an effective way to resolve and receive payment for those claims that are denied due to reasons other than for simple registration errors.
There are many factors to the medical billing process to take into account, and failing to recognize the need to follow up on a claim, resubmit a claim, and/or make an appeal on a claim can cost your practice and your patients time and money.
To make things easier, it is a good idea to utilize medical billing experts to handle the medical billing process, so you can focus your attention on other matters. Contact us today to see how we can simplify the medical billing process in your office.