Avoiding The Pitfalls Of Claims Submissions

Avoiding The Pitfalls Of Claims Submissions

As every health professional submitting claims knows, it is the medical claim with absolutely no mistakes and doesn’t additional information that is what will go through without a hitch. If there is any issue with it, reimbursement will take longer or will not be paid out at all. Therefore, it is important to get it right the first time. It has to be clean from top to bottom.

Let’s look at the most important things that need to be looked at before sending a claim into insurance:

1.    Ensure the patient is covered with insurance when the procedure or service was performed. This should be checked before any service is provided so that the patient knows medical billing servicewhether he/she is covered or needs to pay out-of-pocket.

2.    The claim form should not having any expired codes. This goes without saying, the insurance company will not correct this discrepancy and will send the claim back.

3.    The form should have all relevant information in the correct fields. The patient’s name, address, date of birth, identification number, and group number all need to be entered without error.

4.    The claim needs to be submitted in a timely manner. Waiting to turn in claims is bad practice.

5.    The correct payer, payer identification number, and payer mailing address is entered.

6.    The healthcare provider cannot be under investigation for fraudulent practices and needs to be licensed during the date of service on the claim.

7.    Do not send in duplicate claims. It costs health care providers and health insurers extra costs every time a duplicate claim is filed and processed. It can cause more problems and can be counterproductive for everyone involved. Extra time is used to process claims already in the system, staff time is used to track these claims and fix the duplicates, and providers lose office time completing and submitting them as well. Additional costs can be incurred when a provider pays a billing service to resubmit a claim that is already paying out.

8.    It is helpful to verify benefits prior to submitting claims in order. Check for the most recent policy information available. Also check for any benefit exclusions that may have bearing on the services that are to be performed.

9.    Ask for the member’s most recent insurance card at every patient visit as policies change all the time. The claims can be ensured to be submitted with the most current policy information.

10.    The member’s alpha prefix on claims is an important item to ensure is on the claim form; without it, the claim will not be processed.

Taking the time to fill out claims forms and get the information right the first time is beneficial for everyone involved. It only takes one item to be amiss, and the service will not be reimbursed. Having a medical billing company that is experienced in working with the many payer sources will ensure a majority of claims submitted are accepted. With the many coding changes in the industry, it is best to leave medical billing and coding to specialists in the field.


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