Blog Article

Identify Your Medical Practice Problems By Reviewing The Lifecycle of a Medical Claim

The lifecycle of a medical claim is a very complex process.  There are many aspects that can go very well or many circumstances that can go very wrong.  Opportunity for error and for improvement resides both at the clinic level and the billing level.  Mistakes can delay payments for months.

It begins with a patient phone call who wants to schedule an appointment. Whether or not this is an established patient, or a new referral, this is a critical phone call. The staff member answering the phone must confirm the patient’s date of birth, spelling of their last name and obtain all of the necessary insurance information required to verify eligibility and benefits? It is critical to confirm the details of their current insurance in the event that benefits changed since the last time you saw the patient?

The lack of insurance eligibility and verification results in a multitude of problems for the practice, the patient and the bottom line.  How many times have you either had to turn a patient away once they took the time to get away from work, their family, or other responsibilities only to be told that their insurance will not cover the appointment? Perhaps it has played out differently, and you go ahead and take the chance, see the patient, only to find one to three months later that they are not covered under their insurance for the procedure, or codes you used? Based upon the patients insurance, you may or may not be able to pass that balance to the patient with hopes that they understand and will pay for your services rendered. Most often you are forced to write off this balance increasing your clinic error rate, leaving you unpaid for your time, and decreasing your business’ value.

By taking the time to identify these problem areas, you can stop the leaking of your hard-earned money, and start to realize the financial potential of your practice. It is mission critical to identify your areas of weakness.  Insurance companies thrive on the mistakes of your office staff and billing process.  They are making money off of your patients and you.

Carve out a few hours and sit down with your staff. Go through every area internally where a decision is made regarding a single claim. Work on your internal procedures to ensure mistakes no longer happen. Do the training necessary for those who are not familiar with the procedures.

Improve Medial Practice Revenue Immediately

Verify your medical claims process by reviewing the five areas below:

  • Verify or Double check your data entry and spelling. Oftentimes, a small misspelling or mix up of account numbers will result in a denial.
  • Does your front office staff take a few minutes to explain the pre-verified insurance benefits to the patient? Is prior authorization needed? Let’s face it, patients do not understand their benefits, and insurance companies are changing them up so often, it can get very confusing.
  • How efficient is your patient collection process? Does your staff collect the co-pay, co-insurance or deductible while the patient in physically there. This will increase revenue overnight.
  • Is the physician the patient is scheduled with on all of your practice’s insurance contracts? Many times, a claim is denied or paid at the out-of-network rate simply because a physician is not on your contracts or certified through the insurance company.
  • Submit codes to your billing department as soon as the physician has seen the patient. Verify that the codes you are submitting payable by the patient’s insurance company? Do you have a paid CPT spreadsheet by specific insurance company to see which code has the higher reimbursement? In most cases, you can increase your pay per visit significantly if you utilize a tool like this.

Starting with these five areas, you can easily and quickly see progress in your business’ bottom line and for a minimal amount of effort. You owe it to yourself and your practice to start identifying your trouble spots.

Source: Physicians Practice