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Missing documents, undertrained insurance agents, and inefficient claims denial management are among top reasons that impact medical claims management and processing in health insurance companies. It can result in denial of payment which can be time-consuming to resolve. People responsible for billing may have had insufficient training because they are occupied with new healthcare delivery reforms focusing population health management as well as bundled payment models.

When companies discover that their billing staff is undertrained, it becomes a necessity to expedite their knowledge work on medical documentation. It warrants agents to fill out forms more efficiently and accurately. Also, it is unequivocally important to honor deadlines and to deliver upon promises to ensure a pleasant service experience. Read more to know how claims management process can be improved.

5 proven Ways to Improve Claims Management Process

In healthcare revenue cycle, there is always an answer to how payers could streamline claims management process. The revenue cycle experts are constantly on the lookout for new strategy to combat declining rate in claims reimbursement as well as value-based purchasing. However, streamlining efficiency and cutting cost within healthcare system isn't easy.

While patients look up to hospitals for healthcare service as well as trouble-free claims processing, providers seek efficient medical coders to file claims. Healthcare consumerism and value-based reimbursement are two latest trends that will continue to shape the way healthcare is provided. The onus is upon providers to find a right balance between consumer and market demands.

If you are in a quest to find how to improve medical claims management, fret not. Here are top 5 tips to increase claims management process -

Preserve and Refresh Patient Data

1. Preserve and Refresh Patient Data
Accurate patient data is the key to obtaining best coverage limits. A patient's job profile and age are taken into consideration in Medicare billing process. It is not only important to know policy numbers and deductibles that patients are liable to pay, but also weigh in other factors such as correctness of billing address, policy number, and validation of patient information with payer records held by third-party insurers.

Train and Retrain Agents to File Claims Without Error

2. Train and Retrain Agents to File Claims Without Error
Regular training is one of several ways to improve claims management process. Insurance companies follow distinct set of rules in processing claims and onboarding new patients. Some payers focus on establishing primary care relationship through chart notes, while others use chart notes for non-standard treatment and follow-up care. The team handling medical billing must be thoroughly trained without exception. The training exercise must cover accessing patient data as well as quickly interpreting filing essential and protocols. In this way, every carrier will have the right set of information to speed up claims processing.

Streamline Healthcare Claims Denial Management

3. Streamline Healthcare Claims Denial Management
Handling claims denial may not be easy without a structured plan. Whether you choose to outsource medical billing and coding or handle them in-house, the rate of denial can be significantly cut down by regularly training the team in claims management. Most common reasons why insurers reject claims are as follows -

  • Lack of physician credentialing
  • Incorrect or partially furnished patient demographics
  • Coding bills which for services not availed by the patient
  • Insufficient support documentation
  • Not obtaining referrals or prior authorization for the specialized procedure

Medical practices can enhance the efficiency of claims processing by backtracking coding methods. This can soften the rate of claims denial. If billing team is provided chart notes on a day-to-day basis, it could enhance the accuracy and save time in the long run. Also, if claims are frequently returning to hospitals due to the inclusion of services for which providers are not eligible for claims, it becomes a necessity to relook the coding strategy as well as the verification process.

Analyze Quality Control Measures

4. Analyze Quality Control Measures
One of the best ways to improve claims management process is to periodically analyze the quality so that providers can devote more time on productive tasks. If claims are repeatedly returning to providers, it can interrupt quality healthcare service in a big way. Hence, it is critical to keenly hunt and avoid errors that can cause claims denial. Healthcare providers can closely monitor the health of cash flow by following standard accounting conventions while handling payment records. Keep track of deposit data and forward every receipt as it is to billing team to ensure account balances are up-to-date. Unambiguous deposit logs can help auditors to validate correct payment.
The account log should consist the following data-

  • Name of the patient
  • Patient's account number
  • Invoice number
  • The cost charged for the service
  • Treatment date

Investigate Faulty Claims

5. Investigate Faulty Claims
If there are improperly processed claims, it is time to follow-up with the account. Probing aging account dues can expose incoordination between insurers and patients. It is important to seek answers to some key questions - Is the coding and billing partner working with due diligence and speed? Are statements comprehensible by patients? Is negligence the reason behind billing errors?

Analyzing faulty accounts more frequently will help optimize the performance. It is crucial to form a well-organized strategy that lets you file claims faster, improve revenue generation, as well as smoothen communication with stakeholders. In order to make reimbursements more effective and boost cash flow, review billing cycle of all patients using check deposit data.

Spare your teams from the challenge of troubleshooting returned claims by following our 5 key ways to increase claims management.

Outsource Healthcare Denial Management Services to Flatworld Solutions

Flatworld Solutions (FWS) is an ISO-certified company with 20 years of experience in world-class denial management services. Our well-experienced team has demonstrated adeptness in not only understanding client challenge, but also providing an effective solution which is in tune with the standards sought-after by the industry and exclusive to client requirement. If you are looking for a reliable partner with many global offices and readily available subject matter experts to handle your concerns round the clock, your search ends here. We offer cost-effective services that can fulfill your needs irrespective of the challenges involved.

Contact Us and get an expert recommendation on claims management process. Our team will get in touch with you with a customized quote within 24 hours.

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