Purview Healthcare

Steps To Better Your Claims Processing System

How to Improve Your Claims Processing System

The medical billing process nowadays has transformed into something that includes a lot of approvals, a lot of calling and a lot of work in general.

Let’s face it, it’s complicated and there’s a strict need for somebody to help understand how to approach it in a simpler and more effective manner.

Most of the businesses have a variety of choices for streamlining the coding and billing procedure. This will speed up submission timelines, enhance your first-pass approval rates and improve claims processing in general

But let’s dive a bit deeper into this and decode how exactly can this process become simpler and more efficient.

Transparency in the collection process:

The one place where transparency is much needed is when it involves the patient. Be clear with any new patient about their responsibilities for paying for any service not covered under their insurance.

This can be done by asking them or their family members to fill out a simple form that will allow you to take and give information simultaneously.

This will eliminate any negligence on the part of patients and their relatives. This will also allow your organization to simply collect the billing information from the patient, a copy of their insurance card and other ID details needed at a later stage and reduce the number of repeated calls one usually has to do in order to collect the same information.

Automate Basic Billing Functions

Whether you are a hospital that handles medical billing and healthcare revenue cycle workflow in-house, or an agency that specializes and offers your services to healthcare facilities, automation where needed is always a good idea

AI helps humans focus on tasks that require more nuance, and creativity and which stimulates their minds. This is what retains employees and also makes the job more interesting for them.

Hence, automating procedures that are repetitive and boring in nature can help your organization achieve more in less time. This way your organization can earn a reputation for being more patient-centric than being billing centric.

Whether a practice chooses to handle claims internally or through an external vendor for billing and coding, it is obvious that having a system of checks and balances that ensures high first-clearance rates.

If this is not the case, then it is understood that medical billing professionals need more training. It is vital to identify what step is the faulty one that is causing in the maximum number of denials.

Many healthcare facilities and medical billing services give up after a brief period of time, but here is where one final push can bring in unfound revenue.

There can be loads of reasons for denials. It can be that the Physicians are not properly credentialed or the lack of sufficient support documentation or maybe your team uses codes for services or equipment that are not covered by carriers.

Tip: Early verification and scrubbing the claims prior to submissions can drop your denial rate by a drastic number.

Here is where third-party revenue cycle management companies can help a lot, and outsourcing is the most viable option.

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