The current healthcare insurance reimbursement process is a challenge for most private practices. Getting paid on time and in full takes coding skills, billing experience and seamless revenue cycle management (RCM) processes.
Whether you’re a new practice or a seasoned private physician, optimizing your reimbursement process is one of the most effective ways to increase revenue. And with added revenue, you can grow your business and care for more patients in your community.
Here are five steps you can take today to improve reimbursement from payers.
CREATE AN EFFECTIVE INSURANCE VERIFICATION PROCESS
Knowing whether a patient has active, valid insurance is the first and most important step of your reimbursement process. If a patient receives services at your practice but doesn’t have an active insurance plan, you won’t be able to file a claim and may not get paid for those services.
Creating an insurance verification process at your practice can help make sure you catch any inactive plans before a patient comes in for treatment. Consider running batch eligibility checks a week or two in advance and create follow-up steps for patients whose plans are inactive.
SEND PATIENT ESTIMATES TO INCREASE UPFRONT COLLECTIONS
One of the best ways to improve payer reimbursement is to collect that reimbursement upfront before you start the claim process. You can do this by sending payable estimates before the patient’s appointments. Patients are often more likely to pay a balance for services if they understand the costs upfront.
You’ll also be able to increase upfront collections if you use a communication channel that your patient prefers. That means exploring options for SMS text and email estimates and statements.
ESTABLISH AN EFFICIENT REVIEW PROCESS
One of the best ways to improve reimbursements is establishing a review process for your billing and coding. Beyond claim scrubbing, this process can help ensure you’re reimbursed as much as possible for patient care.
It’s important to note here that we’re not talking about upcoding (submitting a claim for a more complex or expensive service). Rather, we’re talking about using the most accurate and specific CPT code possible for the service you’re providing.
ORGANIZE AND DOUBLE-CHECK PAYER DETAILS
Your team must have a handle on your payer contracts and processes — this is a cornerstone of a smooth claim and reimbursement process. If your payer information is disorganized or inaccurate, you’re unlikely to get paid for the claims you’re filing.
Here are some essential payer details and steps your team needs to consider when improving the reimbursement process:
Make sure your provider credentialing is accurate and up to date.
Don’t forget about insurance verification and ensure your team always submits the claim to the correct insurer.
Verify that you’ve mapped the correct payer and payer IDs in the claim submission software.
MAKE CLAIM CORRECTIONS AND SUBMIT RECONSIDERATIONS
Instead of adding to your write-offs, create a process for correcting claims and submitting reconsiderations. If you make appropriate corrections and submit them along with detailed patient notes, the payer may reimburse your claim after all.
Alongside your claim correction and reconsideration process, make sure your team knows to collect detailed documentation for each patient. That includes encounters, treatments, tests and procedures, and any pre-authorization or pre-certifications you had to get
before the treatment. This documentation can help support your claim reconsideration and increase the likelihood of full reimbursement.
GROW REVENUE BY OPTIMIZING YOUR INSURANCE BILLING
Improving a few areas of your insurance billing process can go a long way in maximizing reimbursements and helping your practice thrive. Whether it’s improving your insurance verification, sending estimates, or finding a better way to review claim documentation, these steps will give your business the cash flow it needs to grow.
If your insurance reimbursements aren’t bringing in the revenue you need, Gentem Health has the expertise to make a difference in your bottom line. With a team of billing experts and proprietary, AI-powered software, we help practices spend less time on billing and more time growing their businesses.
About the Author: Melanie Graham, is RCM Marketing Manager for Gentem Health. Gentem is a best-in-class RCM and billing solution that combines AI-powered workflows and in-depth analytics to help private practices increase collections and grow their businesses. Gentem is a preferred partner of Maricopa County Medical Society. Request a free billing estimate from their team.