Is Effective Denials & Appeals Management what you are seeking?

ByDhana Prabhu

Is Effective Denials & Appeals Management what you are seeking?

Denials are common things in today’s health care scenario. With hectic activities and the continuous need for providing flaw less care to patients, medical professionals and practices may not be fully prepared to efficiently respond to the different types of denials that they face each day. Major issues that prevent responding in a timely manner to denials are staff shortage and lack of expertise or knowledge!

Different Types of Claims Denial

A few of the denial types have been listed below:

  • Medically unlikely edit
  • Medically necessary
  • Partial / No authorization
  • Coding & Documentation
  • Different procedure billed
  • No valid CPT codes

Common Reasons Causing Claims Denial

  • Incorrect patient data
  • Ineligibility of patient: health insurance cover insufficient or terminated
  • Benefits might have exhausted
  • Outdated or obsolete diagnostic codes
  • Authorization or pre-certification missing
  • Modifier is missing or inappropriate
  • Billed as outpatient but Inpatient procedure has been performed
  • Medical records request not received
  • Provider being out of network

How to Manage Denials

It is not surprising that several providers from private practices to multi-specialty facilities are either short of required staff or are lacking the necessary expertise for handling the constant changes that keep occurring in the health care environment. Many are seen to be hectic with their staff already overworked and they do not find time for working on claims denial.

It is good business sense to outsource denials; it allows current staff to focus on future denial prevention as well as prompt collection of dues from patients at the time of providing services.

Effective Ways to Prevent Denials

A major portion of the claims denial may be prevented with appropriate training being imparted to physicians and their staff. By training, staff team is rendered adaptable to the continuous changes that keep cropping in.

Another factor that helps avoid denials is technology advancement. Electronic billing enables accurate billing and prevents claims being released to the clearing house till all corrections have been applied.

Why Rapid Care?

Outsourcing denials to experienced service providers such as Rapid Care Transcription Pvt Ltd helps reducing the reimbursement time frame while ensuring that denied claims may be re-submitted within the required time.

We have been providing medical billing and coding services to medical practices of all sizes since a decade. For further details, please visit our website www.rapidcare.net

ByDhana Prabhu

Verifying Patient Insurance Eligibility Verification Prior to Visit–a good Strategy for Better Accounts Receivable Management

In the present health care sector with several payment options and frequent changes in governmental policies and regulations, it is imperative that insurance eligibility and benefits of patients are verified prior to providing services. Not doing so leads to missing the opportunity to reduce staff time and secure income. Front office staff in physician practices need to be trained for completing this task that boosts revenue while saving time on the back end.

How does the Process of Insurance Eligibility Verification Work?

It must be made a general rule that returning as well as new patients have to bring their insurance identification card or other relevant document for each of their visits. Front office staff must check whether information on the card are correct and up to date. This can be checked with the insurance company’s website or by calling a representative.

In case there is any issue during insurance verification, policies must ensure that patients pay in full for the services provided and file insurance claim themselves. Office staff also need to confirm whether the physician is considered as in-network or out-of-network by the patient’s insurance plan.

Need for Prioritizing Insurance Verification

Verifying patients’ insurance eligibility and coverage is the primary step in maintaining the financial well-being of the medical practice. Prior insurance verification is a strong indicator of AR.

There are several ways to check eligibility, namely, on payer websites, by using software or third-party products, for providing detailed information to office staff. This helps them with AR. Such data not only includes whether patients have insurance coverage but also whether premium payment has been made and how much of deductibles have been utilized.

Details Checked During Insurance Eligibility Verification Process

  • Insurance coverage date
  • In-network or out-of-network coverage
  • Co-pay amount, if any
  • Deductible amount and how much has been met so far
  • Confirming that services offered are covered or whether they need pre-authorization

Having experienced staff and appropriate processes for properly collecting patient information and checking insurance eligibility facilitates streamlined billing and claims process. Following basic protocol regarding eligibility verification ensures timely payment for health care services provided.

Rapid Care Transcription Pvt Ltd is equipped with a team of expert insurance verification specialists and medical billers and coders who will seamlessly confirm that your practice achieves effective revenue cycle management through essential processes. Contact us at info@rapidcare.net!

ByDhana Prabhu

Complete Documentation is Crucial in Achieving Effective Dermatology Billing Process

The importance of comprehensive documentation of patients’ health records cannot be understated. This is an issue that not only influences patient care but also impacts the financial well-being of any dermatology specialty.

Significance of Documentation in Dermatology Practices

Dermatology practices which do not follow high documentation standards will have troublesome consequences. Appropriate documentation of records and health care claims submitted to payers leads to processes being performed perfectly, thus improving the financial stability of the practices.

The medical record that has been directly entered by a physician or dictated and transcribed, forms the basis for understanding the chain of events that occurred, informing third party payers about what processes have been performed and what services were provided. Moreover, certified and experienced medical billers and coders are aware that something that has not been documented has not happened. Appropriate coding can be achieved only when entries in the patient health record are translated accurately.

The Coding-Documentation Connect

Medical coding language is precise. Codes can be assigned only when being supported by documentation. This necessitates complete documentation that offers all relevant information. In dermatology practices, while dermatologists examine their patients, it is essential that they make their observation clear. Minute details such as the location of the examination and findings need to be documented clearly. These details impact the diagnostic as well as procedure coding. Location and size of lesion have to be explicitly described.

Standards Required in Documentation

It is not just the back office’s concern to adhere to documentation standards for accomplishing accurate coding and proper reimbursement. These standards need to meet the expectation of any health care provider who is unfamiliar to the patient. Patients’ past history and treatment details function as guide for their future health management. This is the reason why dermatologists review patients’ history during every encounter.

Thorough Documentation leads to Smooth Reimbursement

With thorough documentation of records, assigning codes becomes easier, thus facilitating submission of clean claims. Need for appeals toward reconsideration does not arise. During payer audit, health care claim can be compared with the documentation; this helps in determining whether proper payment has been received by the dermatologist for the services provided. In the event of the documentation not reflecting what has been described in the claim, the treating dermatologist will get reduced payments and may be liable for potential penalties.

Rapid Care Transcription Pvt Ltd has been providing reliable and efficient medical billing solutions to health care facilities and dermatologists all over the world. We ensure accuracy and quick TAT, thus improving your chances of better reimbursements.