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5 Things Best Healthcare Firms Do During Medical Insurance Claims Processing

Insurance agencies have no control over the elements that determine payment of claims, but there are certain actions that can be undertaken to ensure unwanted costs and frustrations are eliminated.

· insurance claims,insurance,claims management

Efficiency is the name of the game when it comes to running any sort of business, such as healthcare insurance. The demands are high and the processes are intricate. Ensuring that everything goes smoothly during medical insurance claims management is tough, but it's doable if your firm takes the right steps. A firm needs to cut down its expenses during processing, but not at the cost of fairness in settlement, effectiveness and customer satisfaction. Delivering top notch service to a policy holder is absolutely essential when it comes to retaining loyalty and ensuring the holder stays satisfied.

The claims processing is often quite complex and the steps involved are confusing and riddled with manual tasks which lead to inefficiency and vulnerability to errors. The onus lies on the firm to make sure the process is streamlined, errors are eliminated, productivity is maximized and customer satisfaction is achieved, all the while adhering to regulations. This can be made easier if a healthcare firm takes care of the following elements:

1. Electronic Submission of Claims

To eliminate paperwork and chance of errors as much as possible, the HIPAA has made it compulsory that claim transmission is done electronically. Despite the fact that it is much more feasible, it is still a practice not undertaken by the entirety of the healthcare industry. Electronic submission is a quicker process. It takes only a week or two for the claim to process. It also enables online viewing of claim status and offers settlement advice online. It enables any verification to be done online. It decreases occurrence of needless claims denial, is cost effective and has a positive impact on cash flow.

2. Eliminate Inaccuracies

A claim may be put on hold or even denied if certain discrepancies are found in the information provided in the claim. Details such as patient name, date of birth, address, insurance IDs must be accurate. An error in any of these causes a delay that would need to be rectified and the claim would have to be resubmitted.

Percentage of accuracy in electronic insurance claims processing is roughly 80%, as per the American Medical Association. It is imperative that all delays be eliminated. The employees at a healthcare firm must make sure that each and every detail related to the claim is cross checked with the patient and errors, if any, be corrected before filling and submission of forms.

3. Collect Co-payment, Deductible, and Patient Balances

Collect co-pays when the patient is registering. If patient financial responsibility statement is not taken by the front desk, it is not uncommon for a patient to walk away without paying. To avoid any fines or extra charges to the patient, it would be best to make sure that the patient does not have any outstanding balances, if there are any, they should be collected. Any deductibles in the insurance verification must be collected immediately and balance must be settled after the treatment.

4. Invoice the Patient

After the explanation of benefits, the patient must be a sent a detailed invoice. The earlier they get it, the likelier they are to pay it. It is best if the invoice is clear, concise and customer friendly.
E-Payment methods such as online payment should be offered to the customer to quicken the payment process and to ensure ease of the customer as well as the firm.

5. Use Analytics

The stakes are high, and performance must be top notch. An analysis of the process that your firm undertakes during a medical claim will help you pinpoint the weak and strong areas. This will help you work upon what needs to be improved and continue strengthening what your firm is already doing right. Automation will help you as well as it will bridge process gaps and heighten the quality of services provided to members.

Aforementioned practices, if upheld, will help take your healthcare firm to great heights. Close to $17 Billion can be saved by taking out errors from the insurance claims management process, according to a report by The National Health Insurer Report Card. It is impossible to completely eliminate errors, but a firm can work hard to reduce occurrence rate.

Claims processing can be a daunting task. Let us at Cogneesol handle it for you. We are one of the leading insurance BPO companies helping insurance agencies with their back-office functions. Call us at +1 646-688-2821 to schedule your free consultation.

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