Thank you for Subscribing to Healthcare Business Review Weekly Brief
The challenges of running a successful healthcare practice are much greater than providing high-quality patient care. In order to run a successful dental clinic, laboratory, hospital, or solo practice, there are several things you have to get right, including insurance billing.
The challenges of running a successful healthcare practice are much greater than providing high-quality patient care. In order to run a successful dental clinic, laboratory, hospital, or solo practice, there are several things you have to get right, including insurance billing. The healthcare revenue cycle depends on receiving accurate insurance reimbursements.
Stay ahead of the industry with exclusive feature stories on the top companies, expert insights and the latest news delivered straight to your inbox. Subscribe today.
When it comes to insurance claims, medical practices face the following challenges:
Missing and Incorrect Patient Information
Claims are often rejected due to missing or incorrect patient information. Patients' demographics and insurance information are usually not cross-checked by the front desk team. Inaccurate data submission could lead to claim rejection. By using a patient portal, it is possible to verify the accuracy of patient demographics and insurance information. Patients can be immediately informed if inaccurate information is provided by the front desk team. When patients and insurance information are accurate, clean claims are submitted, resulting in faster insurance payments.
Improper Coding
Medical coding is often handled by small healthcare practices or solo practitioners. For all patient visits, they tend to use three to four procedure codes (CPT). Healthcare providers are trained in medical coding, a specialized branch of medicine. Up-coding and other forms of medical abuse and fraud can have more serious consequences, including fines and penalties from the federal government. Coding for medical specialties requires experience and specialized knowledge. Moreover, such coders are hard to find and incur high costs on the payroll.
Non-Covered Services
Most physicians, hospitals, prescription drugs, wellness care, and medical devices are covered by insurance companies. Certain items and services are not covered by Medicare or other commercial insurance companies. Often, patients are unaware that their insurance no longer covers the service they need until it is time to pay. By verifying patients' insurance coverage at every visit, it is possible to overcome this challenge. In case of inactive or non-covered insurance services, check if the patient has additional coverage. Providers should inform patients that they may be responsible for the payment if their insurance doesn't cover planned services.
Missing Referral or Authorization
Some healthcare services require referrals from primary care physicians before patients can access them.
More in News