Four-Point Checklist to Improve your Claim Submission Process

Clean claim submission is essential for your practice to get paid the money it has earned. However, this process might seem tedious and can consume a lot of resources and time from your staff.   

Implementing some strategies in your practice to submit claims properly can help you reduce denials, accelerate the process of being paid, and ensure maximum return for your business.   

Denial prevention is critical for increasing your clean claim rate. Also, taking a proactive approach can help you submit your claims properly and avoid payment issues.   

Here is a four-point checklist to improve your claim submission process:  

1. Pay attention to claim details  

Claims must contain complete, accurate demographics and insurance details. They also need to comply with current federal and state regulations. Deficient and inaccurate data can be a struggle for medical practices.  

According to a poll conducted by the Medical Group Management Association (MGMA), 36% of healthcare leaders reported missing information as the top reason for denials in their organization, followed by prior authorization (31%), eligibility (15%), out of network (5%) and other (13%).  

Your front desk staff is vital in this task. Make sure there are proper processes to collect the data you need to bill for your services and improve your claim submission process.    

2. Understand basic coding guidelines  

Healthcare providers don’t have to know everything about billing guidelines. That’s where the billing and coding team comes in. However, understanding the basics can help providers enormously.   

Some basic considerations you can implement are identifying if a code is primary and putting the diagnosis code attached to the code you are using. Make sure you add the reason for the patient’s visit. These aspects are essential to submit your claims correctly. Some providers put all the information they can in the claim. However, that is not going to help their claims get paid.   

For some information, seek advice from professional billers and coders. They can help you improve the details of your claims. Billing professionals participate in continuing education to keep up with the latest billing and coding rules. Doing so ensures a clean claim submission process and can maximize reimbursements for services rendered.  

3. Verify eligibility & benefits, and authorizations  

Front office staff need to ask multiple questions to ensure they have verified the patient’s insurance and that it’s accurate and up to date. Other processes your front desk staff can consider when improving their verification process are:  

  • Run system eligibility checks to validate the insurance information you have entered into your system.  
  • Have a standardized verification form that all staff can use with each patient, depending on the services offered.  
  • Ensure the questions to be asked of the payer include all you need. This way, you can obtain all the information on the first attempt.   
  • Have a copy of this form and upload it to the patient’s chart, so you have reference information in case your billing team needs it to support a claim.   

Regarding authorization, you need to get prior approval for services that require it. Without authorization, the insurance payer is free to refuse the payment of a patient’s medical service as part of the health care insurance plan. For any service that requires authorization, if you do not obtain one, your claim will be denied and never paid.    

Read more about why you should outsource your authorization process on our blog Why Should you Outsource your Authorization Process?   

4. Have a business intelligence (BI) platform   

Identifying the reasons behind your denials and determining actions moving forward based on data analysis can be a vital strategy for your practice. A BI platform can provide you with drill-down capability to help you understand the reasons behind denied claims.   

Based on that, you will know where your practice has issues and set action plans if needed to correct those.   

Our AdvantEdge Analytics (A2) platform is a powerful web-based tool for medical billing reporting that provides complete transparency and allows you to monitor the entire revenue cycle of the practice, enabling faster and better decision-making.  

Your practice will get complete visibility into the billing process and results. A2 makes medical billing reporting available “anytime, anywhere.” The dashboard shows the results of AdvantEdge medical billing services, including charges, adjustments, payment, A/R, encounters units, and more in summary form.rm.  

At AdvantEdge, we understand the importance of submitting your claims correctly to reduce your denial rate, optimize your practice, and ensure that you get paid for your work.  

Learn how to reduce your denial rate, increase revenue and optimize cash flow by outsourcing your claim submission process. Contact an AdvantEdge expert, or stay up to date on company and industry trends by visiting our Linkedin page.