Optimizing claims for the BEST returns

Are you tired of insurance companies dictating what your collections ratios look like? So are we! While we can’t control every aspect of this issue, there are a few spaces that you do have some control over, and hey, why not control what you can?! Take charge by optimizing your claims and controlling outgoing submissions to get your money FASTER.

Some of the most common reasons for denied or slowly paid claims:

• Missing information 
• Timely filing issues
• Outdated or missing insurance information 
• Coverage limits
• Lack of necessary information for claim filing or incorrect CDT codes

All of these common issues are within your control, when you know how to control them.

Start optimizing your claims process today by doing a few simple things:

• Train your billing coordinator/dept 
• Update your operating software, if needed
• Create an actionable plan that stays consistent and pulls in results! 

Here are some tips to ensuring your claims are going out correctly:

• Verify patients eligibility 48 hours or more prior to their appointment 
  • Ensure the insurance is the same as the information you have, if not, call the patient to gather new information 
  • Check their frequency limitations and remaining benefits to ensure you bill the insurance and patient correctly based on coverage
    • PRO NOTE: not being eligible for a procedure due to frequency limitations does NOT mean that they don’t need the procedure - if the patient needs an exam and has used two of two for the year, the patient still needs the exam and needs to be collected from; notifying the patient of the charge prior to their appointment is a great way to set yourself up for collections success!!
• Take the necessary x-rays while the patient is in the office and file them with the claim on the first go-round
• Take great clinical notes; your claims biller should be able to pull the necessary reasoning for treatment from your clinical notes to bill the claim right, the first time
• Send claims within 1 working day of the appointments to ensure quick payments
• Follow up with unpaid claims starting at two weeks after submission
  • Many practices delay addressing claims until they hit the 30-day A/R, only to learn the claim was "never received".  This delay forces the entire process to restart, pushing payment beyond six weeks from the patient's appointment. 
• Talk about your A/R with your billing department, often. Awareness is key.

Take inventory TODAY, what are you and aren’t you doing from the list above? What can you implement right away to help optimize your claims and payments?

For more help and training, reach out! We’re here for it and we love nothing more than to make sure YOUR business is truly thriving! Schedule a call.

For more tips, check out our latest episode!