| Medical Billing Articles (updated Frequently)
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| Effective Medical Billing: Get Paid On Time |
| By: Pinky McBanon |
Timely medical claim reimbursement/payments for the medical
provider are a serious problem by most of medical practices
nowadays. How can a medical practice survive with slow revenue?
too many claims denial and rejection? The solution here is to
get the collection done as effectively as it can.
Empirically, insurance companies will delay or deny claims
payments! They are very slow on medical reviews,
predetermination and processing claims. I think, that is one of
their business strategies in doing business. They are too is
running their own business' revenues. But if you are a good
medical biller, you are aggressive and can effectively collect
payments in less than the time your provider expects.
Having an effective office manager in your practice that knows
the administrative task is very important. As a provider, you
should be more focused on your patients' care and not on how you
run your practice. Your patients must know their benefits and
eligibility. Encourage your patients to contact their insurance
company regarding their unpaid claims. The insurance is more
attentive when the member makes the phone follow up.
As a medical biller myself, I can collect Medicare payments by
"paper billing" in less than 2 weeks!, you can imagine the
electronic claims submission. I refuse denial and rejection,
because I believe, if the medical service have been rendered, it
is just right to have it get paid. Many of my provider clients
just give up, but, well, I don't. As long as he wants his
payments, I never give up collecting his money.. at the end, we
were successfully got paid. It is just a matter of how you deal
with the insurance and aggressive follow-ups.
Medical claims should be submitted on a daily basis. Never delay
claims submission. Promptly respond "immediately" to insurance
letters that you receive, if they require additional documents,
such as, medical referral, medical prescription, progress notes
and letter of medical necessity to process the claims. Always
comply what they require to expedite processing of the claims.
As a medical biller, you should also be a medical coder. The
doctor gives the diagnosis description on the script but usually
always with the wrong diagnosis code. It is not their concern to
code a diagnosis, but to descriptively provide the diagnosis.
You must know how to analyze and help your provider submit the
right diagnosis code. Analyzing the proper and right diagnosis
code is also very effective to get paid. Remember that when
submitting your claims, the insurance company does not read your
diagnosis' description. They process claims based on the right
procedure codes and based on medical necessity (diagnosis code)
Right procedure, service and supplies coding is also very
essential in submitting your claims (CPT/HCPCS, Modifier Codes).
There are procedures that the insurance denies for payment
because it is NOT medically necessary based on the diagnosis on
the patient. You should understand each insurance company's
payment/fees guidelines.
But here's the thing, "if" the insurance company still keep on
denying your claims, then it's time for them to get notified,
they will be reported for non-payment of claims to the proper
agencies/bureaus if they don't process your claims in 15 days!.
I think, this time they will be more attentive.
Now, here is another issue, you should choose a medical billing
company that will help you do all this. It is going to be a big
decision that you have to make. But here are the things that you
have to consider in making that decision:
(1) Able to handle accounts regardless of the medical practice
account's size
(2) Electronic & Paper Billing Capability with fast-turn around
time
(3) Experienced in analyzing proper procedure and diagnosis
coding
(4) Lesser claims rejection/denial. Efficient in filing of
appeals for denied claims
(5) Knows how to submit claims on worker's compensation and
"no-fault"
(6) Unlimited client support and able to provide full service
medical billing
(7) and the most important thing, they strictly understand,
follow and comply with HIPAA guidelines, rules and regulations.
The Author: Pinky Mcbanon is a Systems Engineer and a Medical
Biller/Coder.
About the author:
The Author: Pinky Mcbanon is a Systems Engineer and a Medical
Biller/Coder.
She shares her medical billing and coding expertise with
http://www.medclaimsplus.com
And she shares her technical support expertise with
http://www.fix-exchange.com (your online source for free
computer technical support!)
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| Keywords: Medical Claim Medical Claim, medical claim reimbursement/payments, follow-ups medical claims, medical billing, medical biller, medical, medical practice, claims, claim, timely medical claim |
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