PracticeForces addresses medical billing and coding in-depth for practices that want to streamline these crucial operational requirements. The claim submission process in medical billing is often a pain point for healthcare providers. Practitioners must understand or translate what each modifier in medical billing means and then wait to discover whether the insurance provider approves the claim.
Read on for how to make that claim submission process less of a hassle.
The Traditional Claim Submission Process in Medical Billing
The claim submission process typically involves the following steps:
- The practice manager completes the form with patient information and service details.
- The manager submits the claim to the Medicare Administrative Contractor, who checks it.
- The claim undergoes a series of edits for accuracy against HIPAA.
- If the required edits are too extensive, the MAC rejects the claim.
Often, this tedious process places providers in an unending claim-denial loophole.
The Anatomy of Claim Submissions
Medical practices and their partners must use extreme caution during the claim submission process in medical billing. Accurate data and complex codes underpin the communication with the MAC and insurance, including details such as:
- Procedural codes
- Diagnosis codes
- Medication codes
- Physician identification
- Basic information about the patient
Low claim acceptance rates delay practice reimbursement from the payer. Plus, that slow revenue stream is on top of the stress and dissatisfaction the patient feels as they wait to receive a much-needed medical service.
How Advanced Billing Solutions Help Practices Improve Clean Claim Rates
Practice managers can implement HIPAA-compliant software and support solutions to increase their claim acceptance rates and receive reimbursements in a timely fashion. It helps needy patients receive the treatments faster, too.
Medical billing services benefit practices in the following ways:
- Automatically update patient information: Patients move or change their phone numbers, and billing services help practices manage these changes via automated updates and information requests.
- Highlight insurance coverage capabilities: Coverage providers frequently reject claims because a plan no longer covers or has never covered a service. Medical billing solutions help practitioners scan for coverage limitations.
- Input correct codes and terminology: Memorizing and inputting medical codes takes time and training. Medical billing services program their solutions to anticipate all these codes.
- Produce accurate claims with no errors: Medical billing services have the flexibility needed to produce clean claims. Swift reimbursements, streamlined financial management, and improved patient satisfaction follow suit.
About PracticeForces
Mistakes happen easily with forms, and high claim rejection rates abound for medical practices. PracticeForces handles these operations daily in Florida. Find out more about the company and how it can improve your claim submission process in medical billing by calling 727-202-5429 or connecting with the team online.
