Healthcare reimbursement is defined as the payment that the hospital, doctor, health facility, or any other healthcare providers get by providing medical services. Usually, the health insurer or a government payer covers the cost of all or part of the healthcare service. Efficient medical coding and billing, is critical to speed up the reimbursement process. In the healthcare industry, financial fitness is closely related to accurate medical coding and claim processing this is why mostly medical billing companies are hired to handle the process.
There are several resources involved in the healthcare billing and claim submission process. It starts when a patient avails the services of a provider; the services are then coded into claims by a biller. The insurance company evaluates the payment claims and approves or denies the claim.
Let’s discuss how accuracy in medical billing and coding is critical to speed up reimbursements.
The most important part of healthcare is providing quality care and getting paid for the services provided. Essential patient care must be followed by accurate coding and creating accurate bills. Care providers and physicians enter the procedural notes with details of medical conditions, diagnoses, and medical procedures performed. Accurate clinical data can help to develop clean payment claims that are the first in the collection process.
Denied, Rejected, and Approved Claims
There are some types of decisions that insurance companies take when you submit a claim: the claim is accepted, denied or rejected.
Accepted claims: When the insurance payer has no objection over the payment clams and finds the provided information accurate then they accept the claims and reimburse the bill. For a claim to be accepted, it is necessary for the information to be accurate in the coding so that the payer can easily hand out the claims.
Denied claims: Claims that are determined that they do not meet the requirements and have errors in them are denied. As the insurance company wants to know what services, tests, procedures, and medical devices were performed. While these can be submitted again for appeal, denied claims often come out because of a mismatch between the coverage and information of treatment and the insurance guidelines.
Rejected claims: Claims are rejected because of any error. The insurance company may as well reject a claim due to the wrong input by the medical biller. As the information might seem to be out of place, the claim may be rejected. As soon as a medical billing specialist corrects the errors of a rejected claim they can re-submit to claim the payment again.
Denied and rejected are the types of decisions that care providers don’t ever want to see when they have to collect payment for services that they had provided. Some of the most common reasons that a claim would be denied or rejected are coding errors including upcoding, unbundling, double-billing, or coding oversight. It is the shared responsibility of the physicians and billing staff to bring accuracy to clinical information. Physicians must see that the procedures performed aptly correspond to the diagnosis and they have provided sufficient clinical notes for the understanding of the billing staff. In a similar way, it is the responsibility of the biller to accurately transcribe the clinical procedures into corresponding codes. Accuracy in the ICD and CPT coding is important to create accurate bills. Preparing accurate claims is all about the accuracy in the coding and billing.
Documenting Accurate Information
The only way to receive rapid and full payment is to document accurate information. If the correct codes are documented, then reimbursement chances are higher. If the payment process is inaccurate it can cause more difficulty for the coders. The patient chart will is required to check with the physician for corrections. When the coding is accurate, payers accept the claim, and providers receive quicker approvals.
This may seem like a simple tip but it involves many factors. Trained staff means that they know all the coding details for your specialty, they understand the state requirements and the guidelines provided by the insurance companies and most of all they are well-informed about the latest changes in the coding. A trained billing staff can reduce the chances of rejections and minimize the denials. If it is deemed difficult for solo physicians or small practices to hire highly qualified staff and keeping them updated with training, then they must outsource the billing and coding to a professional billing company.
Coding and billing is an important part of the whole collection process. With accurate coding, providers get timely reimbursed and meet revenue targets. Train your billing staff to code accurately and scrub the claims before submission. Automation, billing software assistance by medical billing companies and involvement of billing experts leads to higher reimbursement rates.