Evaluating the Procedural Constituents of Medical Claim Management Cycle

Given the alarming statistics about medical billing industry average – 14% of all claims submitted to the payers are denied and have to be resubmitted, appealed or written off by providers, 50% of denied claims are never re-filed, and 50-70% of denied claims have higher chance of being recovered – physicians’ reasoning seems to be amply justified, and impossible to think of practicing without a dedicated medical billing consultancy.

Unlike the general perception of medical billing being just claim submission and realization, Medical billing has grown to be quite an arduous task for the practicing physicians, clinics, and multi-specialty hospitals. While physicians have tried to off-load the burden through in-house medical billing practices, the results have not quite matched up the requisite level of benchmarking prevailing in the health insurance reimbursement environment.

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Faced with the undesirable prospect of dwindling revenue generation, they are convinced of the efficacy of migrating to outsourced medical billing solutions that can effectively and efficiently manage medical billing management. Given the alarming statistics about medical billing industry average – 14% of all claims submitted to the payers are denied and have to be resubmitted, appealed or written off by providers, 50% of denied claims are never re-filed, and 50-70% of denied claims have higher chance of being recovered – physicians’ reasoning seems to be amply justified, and impossible to think of practicing without a dedicated medical billing consultancy. But, then, choosing competent solution providers amidst numerous players can sometimes be misleading. Therefore, it is implied that physicians exercise discretion as to the credentials of their prospective service providers.

Responding to the necessity, Medicalbillersandcoders.com (www.medicalbillersandcoders.com), a credible source for comprehensive medical billing management across the whole of the US, has ingeniously come up with a yard-stick for aiding physicians while they are stuck at deciding their prospective solution providers. A guideline of sort, the yard-stick, proves to be indispensable in establishing the prospective service providers’ adequacy in:

• Patient Registration
  Generally known as Appointment and Scheduling, Patient Registration enables entering patient demographics information and registering a patient, followed by appointment scheduling in the healthcare center.
• Eligibility Verification
  Indispensable in establishing the authenticity of the health insurance policy, screens the health insurance policy in question for being eligible to be reimbursed for medically necessary services.
• Claim Generation
  Claim generation, also known as billing for medical services rendered by physicians, is the documenting for reimbursement on behalf of physicians.
• Claim Submission
  Claim submission, generally known as forwarding the actual charge to the concerned insurance carriers, is an important process in realizing the reimbursement on medical services provided.
• Medical Coding
  An important exercise in the process, Medical Coding is the apt assignment of AMA’s approved CPT/ICD codes for diverse medical services. Consequent to conforming application coding system, physicians’ claims can look at substantial decrease in denial or delay of insurance claims.
• Charge Entry and Cash Posting
  Given the prevalence of multiple specialties and multi-payer system (both private carriers as well as Medicare, Medicaid Schemes), charge entry and cash posting offers superior payment convenience and flexibility, including the collection of co-payments, co-insurance, and deductibles while enabling the scheduling of automatic payments from a patients credit card.
• A/R Denial Management and Claim Follow-up
  Amidst the prevalence of denials or delay, A/R Denial Management proves to be significant in reducing the probability of denial or delay, and expediting Account Receivables as early as possible. Additionally, claims are resubmitted with suitable modifiers, and followed again with the concerned insurance carrier.
• Appeals
  Appeals become inevitable when the insurance provider rejects to entertain your claim. Consequently, as the claims need to be appealed internally or with the Federal Attorney, a preliminary screening for the availability of ‘Appeal’ service should brand your prospective service provider as credible or otherwise.

Alternatively, entrusting your medical billing needs to the proven credentials of Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – complete with Patient Enrollment, Insurance Enrollment, Scheduling, Insurance Verification, Insurance Authorizations, Charge Entry, Coding, Billing and Reconciling of Accounts, Denial Management & Appeals and Physician Credentialing – should ensure simplification of revenue cycle, appreciable increase in collection rates, more patient inflow and referrals, and increased avenue for medical research and development.

Browse all: medical billing service, healthcare medical billing