Medical Billing Blog: Section - Claims

Archive of all Articles in the Claims Section

This is the archive containing links to all articles written in the Claims section of our blog.

Click any of the article links below to read the entire article or browse another section to the right to read articles on another subject.

20 Very Important Aspects of Medical Billing

These 20 aspects collectively contribute to the effective and efficient management of your medical billing process, optimizing reimbursement and minimizing the risk of claim denials. Patient Information: Accurate collection and maintenance of patient demographics, contact details, and insurance information. Insurance Verification: Thoroughly confirming insurance coverage, including eligibility, benefits, and any pre-authorization requirements. Medical Coding: Precise assignment of codes (ICD-10, CPT, HCPCS) to document diagnoses and procedures accurately. Charge Entry: Entering coded information into the billing system to generate claims for submission. Claim Submission: Timely submission of claims to insurance companies, adhering to specific guidelines and deadlines. Claim Rejections and Denials Management: Proactive resolution of rejected or denied claims, identifying reasons

Published By: Melissa Clark, CCS-P | No Comments

The growing importance of patient collections

Patient collections have grown in importance in the healthcare industry for several reasons. Here are some key factors contributing to the increased emphasis on patient collections: Rise in High-Deductible Health Plans (HDHPs): The prevalence of high-deductible health plans has increased, shifting a larger portion of healthcare costs onto patients. As a result, providers need to focus on collecting payments directly from patients to cover these higher deductibles. Increased Patient Financial Responsibility: Patients now bear a greater financial responsibility for their healthcare expenses. This includes co-payments, coinsurance, and deductibles. Effective patient collections are crucial for healthcare providers to recover these out-of-pocket costs. Changing Reimbursement Models: The shift from fee-for-service to value-based

Published By: Melissa Clark, CCS-P | No Comments

Can you save money by outsourcing your medical billing?

Outsourcing your billing can potentially save you money, but it depends on various factors such as the size of your practice, efficiency of the billing process, and the cost structure of outsourcing services. Here are some ways outsourcing medical billing can save you money: Reduced Overhead Costs: Outsourcing eliminates the need to hire and train in-house billing staff, which can reduce costs related to salaries, benefits, office space, and equipment. Efficiency and Accuracy: Professional billing companies specialize in this area and often have dedicated teams using advanced software to handle billing tasks accurately and efficiently. This can reduce errors and rejections, leading to quicker reimbursements and fewer denied claims. Focus

Published By: Melissa Clark, CCS-P | No Comments

Defining the Role of a Medical Billing Clearing House

The importance of a clearing house in the medical world cannot be overemphasized. Also called Third Party Administrators (TPAs), clearing houses make healthcare payment seamless by serving as a link between the hospital, patient, and insurance provider. The role of the clearing house is to interact with the billing system of a hospital, clinic or physician’s office to evaluate medical claims. It sets up necessary documents for patients with claims before forwarding them to the insurer. Typically, a clearing house has strong ties with various insurance providers. Clearing houses aren’t restricted to just collecting documents and ensuring proper documentation for the claim/claims of patients, they are also saddled with the

Published By: Kathryn Etienne, CCS-P | No Comments

The Importance of A/R and Outstanding Medical Claims

Accounts receivable (A/R) management is an integral part of the medical billing process and it is crucial for the financial stability and success of healthcare facilities and medical practitioners. Accounts receivable is referred to as the sum of money owed to the medical practitioner or healthcare provider for the service provided, but not yet paid. The medical services that are rendered by physicians, nursing homes, therapists, laboratory technicians, and hospitals are continuously increasing. An efficient insurance model assists a medical practice in recovering overdue payments from insurance carriers easily and on time. This is when a diligent A/R employee, or department is important, they assist the healthcare provider in being

Published By: Melissa Clark, CCS-P | No Comments