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5 Ways to Successfully Process Medical Insurance Claims

Managing medical insurance claims in an effective manner can be a complex duty. We say this because each process comes with numerous steps. Not only that there are variations in processes. Therefore, we have decided to share with you five successful ways to process medical insurance claims that we have found useful and effective.

1.Gather All Patient Information Accurately

Make sure that you gather all the correct information about the patient. If you don’t this can create a further problem down the road. Not only can it cause problems, but it can lead to lost revenue and you don’t want that. Most common mistakes that people make are spelling the patient’s name wrong, birthdate, address, and insurance policy number. Review all the patient’s information carefully and thoroughly to prevent these common mistakes. Also, don’t be afraid to ask the patient to verify the information that you have.

2.Collect All Patient Balances

It is very common that patients aren’t billed at the beginning of treatment. This often leads to patients not paying because they walk out or don’t have a financial method to pay. Therefore, it is important for the front desk to collect co-pay payments before any form of treatment is initiated. Also, before a treatment option is finalized it is important to break down the cost of the treatment to help figure out a payment plan or if it is going to be billed to the insurance company.

If a deductible already appears on the patient’s insurance verification, a small deposit amount must be collected from up front and the remaining balance amount must be settled after the treatment has been completed. If the patient has already met their deductible maximum elsewhere, it is better for the insurance company to mail refund checks instead of following up to write off an uncollected balance.

3.Invoice the Patient a Detailed Breakdown of Services

Patients will receive an invoice after the explanation of benefits (EOB) has been posted. If a patient receives the invoice shortly after their treatment then they are more likely pay than those who had to wait longer for their bill. Be sure that the invoice clearly states the following: services performed for their treatment, date of service, payments they already made, insurance reimbursement received and any other remaining balance amount.

4.Submit Claim via the Internet

Submitting an insurance claim over the internet saves one time and sifting through physical paperwork that would have to be mailed in. Also, it is a requirement from the HIPAA. Electronic claims have a fast turnaround of a week or two. You can most likely keep track of where your claims too which is a nice bonus. Be sure to double check all forms before submitting!

5.Monitor Insurance Reimbursement for Patient

Lastly, it is important for you to monitor insurance reimbursements for patients. Check that numbers are accurate in terms of what the insurance company is paying and what the patient is paying. Also, review that all reimbursements are honest and are what the patient is expecting. Be prepared to make an appeals denials or if there was a problem with reimbursements.

We hope that you found this article to be useful. Be sure to check all claims for accurate information before you send them in and that everything that was supposed to get covered financially by the patient and the insurance company. If not, be prepared to do an appeal.