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Reimbursement Cycle: How to Improve Claim follow-up Effectively

Reimbursement Cycle: How to Improve Claim follow-up Effectively

Medical providers often encounter challenges with claim management with patients and insurance companies during Medical Billing. Lack of documentation, trained staff, or resources may result in claim denials and revenue delays that are rightfully yours. Often, the owners of the healthcare facility themselves aren’t equipped with the skills to deal with claim management obstacles head-on.

As a medical provider, when you understand your facility requires thorough claim management expertise onboard, that’s when revenue goes on the rise. Let’s explore some of the proven ways healthcare providers can improve claim management. 

  1. Maintain Patients’ Data

Maintaining documentation of your patient’s data is important to devise a course of action when claims arise. It’s important to know their personal information and how they comply with Medicare policies. Along with these facts, medical staff should also ensure the information stored is error-free. If claims are repeatedly made due to mistakes in billing, invoices, or stored information in the database, it could cost your facility time and significant revenue. 

  1. Train Your Staff

Claims management requires a well-trained staff equipped with the knowledge of any and every policy set by the insurance companies. The training includes but is not limited to the skills of maintaining impeccable documentation, knowing and interpreting codes, meeting claim deadlines, and ensuring error-free information. This will significantly enhance your claim follow-up and management. 


  1. Streamline Claim Denials

You may need to install a structured plan to best handle claim denials. Medical providers can choose to outsource a medical billing expert team or build one in-house. Just by having a team especially put together for Claim Denial Management, a healthcare facility can significantly cut down on the denial rate. The most common reasons for claim denials are:

  • Incorrect or error-prone information of the patient. 
  • Lack of any credentials of the physician or doctor onboard. 
  • The coding of the services is incorrect. 
  • Lack of supporting documentation. 
  • No approvals or referrals of special or significant procedures. 

Once a medical provider has these factors under control, the rate of claim rejections begins to soften. If the billing team is provided with chart notes regularly, this could save time and increase accuracy in data-keeping. If frequent claim denials are coming, it becomes essential to look into the root cause and formulate a new coding and verification strategy. 

  1. Quality Control

The most efficient way to improve claim management is to ensure the quality of the processes in place. This utilizes the calculated amount of time for the medical staff, while they can focus on caring. If claims are returned to the medical facility, it’s an indication that quality has been compromised. It is critical to eradicate errors and hunt for any coding mistakes. Employing resources on the same task over and over will become expensive and eat up revenue. Healthcare organizers should keep a check on deposit data and share receipts with the billing department daily. This ensures the data is up to date, any errors are taken care of instantly, and claim denials significantly decrease. 


  1. Investigate Claims

For any account that is continuously delivering claims, it’s best to follow up and figure out where the problem essentially lies. Most accounts depict inconsistencies between patients and insurance companies. It’s significant to hunt for answers, and investigate if your organization is receiving claims due to errors in medical coding, your associate billing team, or data entry issues. 

Analyzing faulty accounts will assist your team in enhancing their performance and prevent for those claims to form a pile. This will also significantly improve the revenue of the business. To ensure everything is running smoothly, the medical staff should review billing cycles and maintain a check on the deposit data. 

By conducting timely investigations, your staff will not be overwhelmed by paperwork when claims arrive. 

Bottomline

Managing your claims can be crucial and by far one of the most important parts of medical billing. Your healthcare facility, at the end of the day, is a business. You would require a consistent cash flow to run operations smoothly, while recurring can mean the opposite of that. It’s best to stay on top of your game and manage the errors resulting from these claims. It would significantly boost your revenue and the word of mouth of your facility amongst patients, insurers, and medical staff. 

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