If you’re a healthcare professional or manage a healthcare facility, you know that filing health insurance claims is a necessity. Yet, it can also be a hassle. Each health insurance company has its own rules regarding how claims must be filed. Then, there’s the need for pre-authorization for many treatments. If the proper ICD codes aren’t used or your office uses the wrong forms, you may not get paid. That’s why optimizing your health insurance claims filing process is so important. Follow these 7 steps to improve your health insurance claims filing.
Step 1 –Confirm and Update Insurance Information at Every Appointment
This is actually one of the most important steps that you can take to optimize your claims filing process is to make sure that your frontline employees confirm and update health insurance information for every patient each time they come into the office. Ask to see the patient’s insurance card during the check-in process. Compare it with the information that’s on file. Make a copy of the front and back of the card if anything has changed. Any changes should be immediately made in your internal systems.
Step 2 – Collect the Required Co-payment
Because it can take days (and sometimes weeks or months) for an insurance company to send your office its payment, it’s important that your frontline staff collects the required co-payment at the time of the appointment. That’s much needed capital for your business.
Step 3 – Regularly Review and Update Billing and Health Insurance Claims Procedures
Since health insurance companies may have different procedures and forms that your office must use to file claims, it’s important to review and update billing and health insurance claims procedures. It’s also important to ensure that your billing and coding staff is using the most updated ICD codes. Using an outdated code can stop you from getting paid.
Step 4 – File Health Insurance Claims Every Day
Health insurance claims should be filed as soon as possible, but by no later than the end of the day. One way to accomplish this is to make sure that you have enough team members whose job it is to handle billing and claims. Daily claims filing is important because it prevents a backlog from forming. It also helps prevent errors that may occur when billing specialists are in a hurry because they have old claims that they must handle.
Also, when health insurance claims are filed, it’s important to make sure that you file on secondary insurance if the patient has it.
Step 5 – Review Open Claims Each Month
Your office should review open claims at the end of each month. This will enable your staff to doublecheck if a claim was paid and not properly recorded, if the claim should be resubmitted, or prepare to contact the health insurance company to determine what’s causing the delay.
Step 6 – Call on Unpaid Health Insurance Claims Within 60 Days of Filing
Instead of continuing to resubmit a claim, pick up the phone and call the health insurance company. This can help your office determine why the claim was denied. It also prevents the filing of a duplicate claim. You can also establish a working relationship with long-term health insurance company reps and ask them for their direct phone number. This can help make your claims filing process more efficient because you know to whom you can reach out if claims are going unpaid.
Secondary insurance claims should be followed-up on if they aren’t paid within 90 days. You may need to submit a hard copy along with the explanation of benefits for these claims.
Step 7 – Create a Log to Document Follow-ups
You should create a log to document follow-up conversations that you have with health insurance companies. You should use the log to document the date, time, subject, and important points of phone calls, emails, or letters that you receive from the company related to a claim.
Professional Services for Healthcare Facilities and Providers
Clients ARM provides billing, ICD coding, and electronic health insurance claims filing services for healthcare facilities and providers. By choosing Clients ARM, you’re getting 30 years of professional billing and coding experience at an almost 40% savings when compared with the expense of hiring a full-time employee. To learn how we can help you with your billing, coding, and health insurance claims filing needs, schedule your free, no obligation consultation with our CEO by clicking here.
