For any medical practice to maximize its revenue, it is essential that accurate claims are filed and they meet the various stipulated reporting guidelines. Moreover, denials need to be tracked and appeals need to be filed in a timely and appropriate manner in accordance with Medical Group Management Association. While a few problems regarding reimbursement may be handled by the back office, others must be managed by a practice’s front office. The crucial steps through which compliance and coding may be improved—leading to an increase in the revenue—are given below:
- Delegate Claims Tracker in-house
- Depending on your human resource availability, designate a separate person to identify and flag claims which are nearing resubmission deadline and to manage denied claims appeal- along with updating additional documentation required. The job includes ensuring that payer has received the resubmission on time and following up till reimbursement
- Learn from Denials
- Taking time and evaluating denied claims assists in preventing such future denials – this may be done by using software that identifies and traces errors before submission of claims, or by making use of manual resources to closely watch for the common denial reasons given under:
- Pre-approval Documentation being missed or Authorized Beneficiary Intimation being missed
- Ambiguity over whether a patient is established or new – this distinction is important
- Deadlines being missed
- Conflicts regarding who the primary payer and who the secondary payer is
- Not being included in the covered items may led to denial
- Clean claims must be first sent to payers who frequently deny claims
- Involve physician and other professionals’ participation in coding
- Let providers be accompanied by a coder
- A coder may effectively note down vital information that can later be compared with that of the provider – this will reveal facts.
- Keep updating about coding resources and regulations
- Just as new ICD-10 codes needs to be implemented, AMS also revises the CPT books – make sure that your practice uses the most updated resources
- Go through the medical service provider’s notes carefully, prior to coding
- For ensuring that essential data is not missed out, coders have to read through the provider’s notes thoroughly without leaving any portion
- Delegate claim-related tasks to a skilled & reliable claims service provider
- There are trustworthy companies that provide billing and coding solutions along with documentation of claims – entrusting your coding and billing assignments to experts not only improves reimbursement rate but also enables you to achieve considerable saving
Improve reimbursement while achieving compliance. Partner with Rapid Care for relieving your practice from all claim-related issues. Start enhancing your revenues!
