Patients handing money to doctor.

Next-Level Claims Management and Healthcare Reimbursement

When it comes time to collect payment for services, healthcare providers have it different than many other service industries. Claims management in healthcare us an added step in payment collection for medical practices. 

Providers render services to their patients and often have to wait at least a month to collect payment. Understanding the process for quicker payment collections is important in order to reach next-level claims management and healthcare reimbursements.

How Does Claims Reimbursement in Healthcare Work?

1) Patient Intake

Collect information about the patient and family history. Any information that could be relevant to their overall care is important to have on file. This serves as the foundation of clinical decision making and future billing claims.

2) Document Everything

During and after the visit, providers must document every detail of the visit and describe how they formed their conclusion. The information regarding how the provider formed their decision is necessary when filing a claim. It proves the need for services and reason/necessity for healthcare reimbursement.

3) Medical Billing Codes

Next, the provider must assign the most relevant medical billing code to the claim. Medical billing codes are always changing, and providers must label the correct one to ensure healthcare reimbursement for their claims. If the wrong code is assigned to the claim, it will most likely be denied. This will delay the time that the healthcare reimbursement is received by the practice.

4) File the Claim

The next step in the process of healthcare reimbursement is to file the claim. Filing the claim means sending it to the payer for review. Providers are able to file claims individually or in bulk, depending on the services they offer and the software they utilize. During the review process, the payer determines whether or not they are willing to offer a healthcare reimbursement for the services the provider rendered.

5) Receive Healthcare Reimbursement/Resubmit Claim

One of two things can happen after a payer reviews a filed claim. The claim will be approved, and the provider will receive a healthcare reimbursement, or the claim will be denied or rejected. When a claim is denied, the provider has a small window to resubmit the file with updated medical billing codes in hopes of approval the second time around. If the claim is still denied, then the full responsibility of the payment falls into the lap of the patient.

Resources to Improve Claims Management & Healthcare Reimbursement:

1) Outsource RCM Services

By outsourcing RCM services to a trusted vendor, providers remove many of the claim’s management responsibilities over to their vendor. A team of expert billing professionals helps your practice improve clean claims through a variety of different services. These services might include claims scrubbing, which is accessing a claim prior to filing it to ensure everything is in line for a first-time approval. Other services include claims tracking to pinpoint claims the moment they are denied and the management of difficult collections. By outsourcing RCM services, providers will increase the speed at which they receive healthcare reimbursements without overusing their in-house resources.

2) Medical Billing Software

A quality medical billing software enables providers to integrate fully with their electronic health record to optimize patient payments while also improving your in-house billing workflow. Medical billing software can help improve your reimbursements by bringing to light common billing inefficiencies and coding mistakes to help your team accomplish its best work.

Optimizing your claims management process with RCM Services and medical billing software is the key to growing and protecting your bottom line without sacrificing your financial and operational resources. To learn more about tools that can help your practice achieve better billing results, click here.



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