7 Simple Steps to a Clean Medical Claim Submission Process
A health p[rofessional always struggles with finances if they don’t have good resource to deal with it. The medical part can be handled by the professional but the finance part requires an understanding of how things work in the finance world. That’s why health professionals take help from finance experts and third parties for such services. One such service is G.I Health solutions.
One of the financial issues faced by health professionals is medical claims. Medical claims can cost you a lot if not tackled properly. But first, you have to understand what’s a clean medical claim?
Clean medical claim submission is a process in which the health professional in order to get reimbursement provides the regulatory authority a billing plan within a year after the end of services. The billing needs to be clean and clear in order to get approval. If it’s not it can delay or sometimes stop the payment of the health professional.
Then how can you, as a health professional like G.I Health Solutions, claim a clean submission? Well, these steps will help you.
Check Insurance and Verify It
When a p[atient walks into your medical facility it is your duty to check their insurance plan and verify it. Different patients have different plans. Some plans cover a few facilities and it is important to check if the patient coping with his plans has the coverage of your services or not.
Another tip is to verify the insurance throughout the service like G.I Health Solutions. If patients change the plan or alter it to the original they might face problems while filing a claim. You should also check the number of visits, covered services, or benefits. All of the verifications and confirmations should be done before putting up the patient’s profile into the billing software.
Double Check The Patient’s Information – G.I Health Solutions
If you don’t want your claim to get denied the key is to put accurate information. If the patient is dealing online then verifying the personal and insurance information is very important. Maintaining the record, the number of visits, services, and benefits will help you in clean claim submission.
One of the most important things is to complete all the prerequisites before the service., You should check the insurance plan to see if your services are covered by the insurance plan. Always do the pre-certification if you want a successful claim. Before entering a patient into the billing always check the insurance plan type. Some people have a primary plan, and some have a secondary plan that will affect your claim. The plan type will define the nature and length of the service. The type of insurance plan will help you see how many days and what type of treatment is covered by the insurance. To verify all of this the basic profile of the patient and their insurance must be correct and double-checked by the billing staff.
Check Eligibility on Time
This step is an important one to save yourself from the claim rejection. Two days prior to services check the eligibility and make sure the services are covered by the insurance company. Before every appointment makes sure to check the services because there are chances that the patient has made changes in their insurance plan.
This eligibility will help you maintain a steady cash flow and quarrel-free transactions. This step will make your service profitable and will make your customer updated about their insurance plans before the appointments and visits.
Timing Is Everything
The timing in claiming a clear submission is everything. There are different timelines for different services. Mostly it starts with the date of service to 90 days and some may offer no later than a year. It is crucial to submit the claim on time so that you can get your payment on time. If you delay it chances are you will not be getting a penny.
Documentation should be proper – G.I Health Solutions
Nothing will get straight if you don’t have a proper documentation process. Maintaining your billing files and systems and documenting everything is going to set your record straight. Most of the claims do not get what they filed for because of poor documentation and missing information.
Know The Upgradation In Coding Regulations
Medical coding often changes and the regulations associated with these codes can cost you a lot. The best way is to keep yourself updated with the new medical coding regulations. Submitting incorrect codes will lower your chances of getting a claim and in case of getting something, it will not be worth the trouble.
For a successful claim, know all the regulations of your insurance company as well. The general guidelines are the same for all medical insurance but there are types of insurance that vary from company to company and their rules and regulations also change from time to time.
Maintain A Steady Data Sharing System – G.I Health Solutions
Losing data is a very common reason for claim failure or losing a percentage of it. That’s why maintaining a proper channel for sharing information is very helpful for a successful claim. You can ask your IT service provider to maintain a steady data sharing flow from your practice management system to the electronic health record. This will not only help you maintain your client’s profile but will also help you maintain your billing system. This way you can avoid data loss which is possible when entering information manually.
Conclusion
Medical is no doubt a sacred and noble profession but at the end of the day, it is business. To make a balance between business and your profession you should take guidance from experts like G.I Health solutions. Your medical services business needs money to help people get better and that’s why getting successful claims and reimbursement is your ideal situation.
Follow all of the steps mentioned above to get a successful claim and you will not only elevate your business but will also help people get better. Insurance is not only to help people but also medical practitioners and that’s why you should be very careful with your claims.