Streamlining Reimbursement: Strategies for Success with Medicare’s Fee Schedule

A healthcare provider’s bread and butter are medical claims processing. It is the process through which the total sum owing for a treatment or operation is delivered to the insurance company in order for it to fulfil its agreement with the patient. On the provider side, it entails evaluating the billed amount for coding and coverage before submitting it to the insurer. Learn strategies for streamlining reimbursement with Medicare’s fee schedule.

Claim processing is complex since it necessitates completing at least a dozen procedures before submitting the bill to the payer. Some systems must be updated because many practices still rely on paper medical records. Those that rely on something other than paper-based transactions have additional challenges, such as a shortage of skilled people and a high turnover rate. To assure accuracy during this complex operation, there are techniques to improve claims processing efficiency.

Given that the average American spends $8,000 per year on healthcare, the majority of which goes towards health insurance, healthcare providers must discover strategies for success with Medicare’s fee schedule to streamline reimbursement. A few of them are as follows:

  • Collect all the Required Patient Information

This is the most efficient medical billing method as most hospitals and clinics now have far more relevant data than just the patient’s active health insurance provider, contact number, and personal address. Access to information such as preferred contact times, email addresses, and other details can help to build the relationship between doctor and patient. It also increases the likelihood of quickly contacting the patient about critical information, resulting in immediate remedies.

Furthermore, patients are pleased and appreciate the clinics’ use of this successful strategy. However, it is equally critical that every healthcare professional’s clinic adheres to HIPAA standards, particularly concerning privacy. Efficient medical billing allows the healthcare system to focus on the most vital areas of the system, resulting in the greatest possible patient care!

  • Put the Patient as a Priority

Healthcare clinics can have excellent medical billing procedures, but first, they must improve patient relationship management. If the clinic’s staff prioritizes patients’ needs and believes in enhancing patient happiness, it will assist in developing a strong bond and loyalty with the patient. Staff must provide patients with both verbal and written descriptions of their financial obligation, deductions, preferred mode of payment, copays, and the best time for their visit, among other things.

  • Use of Updated Technology

Most of the time, many claims are automatically refused when submitted. This could be due to outdated technology, therefore keeping clinics up to speed on diagnostic codes and criteria. It takes a long time to search for and resubmit underpaid claims. If the clinic has automated software systems, they can simplify eligibility checks, prior authorizations, and medical coding and notify you of any problems before filing claims. Modern technologies may shorten the time it takes to receive reimbursements.

  • Improve Charge Capturing & Coding

Healthcare and hospitals must establish and implement mechanisms to capture revenue for patient services. Outpatient nursing treatments, such as injections given to patients, are examples of areas that can readily avoid charge capture throughout the billing process. Other times, pharmacy revenue is lost because of inaccuracies in unit reporting. Thus, nurses and chemists should check for missed charges and other papers to ensure proper reporting of missed payments.

  • Outsourcing Claims Management Services

Medical claims management is a specialized activity that a team of professionals should handle. Outsourcing medical claims processing to 24/7 Medical Billing Services is the most convenient way to handle it. Healthcare providers overwhelmed by claims processing or attempting to streamline the process might rely on third-party service providers to help them overcome the associated problems.

A back-office support company can assist you in overcoming all claims processing issues. Their end-to-end support procedure encompasses all aspects of claims processing, from handling health insurance correspondence to quality control.

The most significant advantage of outsourcing claims management to healthcare claims processing professionals is that it allows you to focus on other activities. Furthermore, it assists you in saving money and combating challenges such as attrition, quality, and training. Tasks such as resolving monetary questions for patients or obtaining prior authorizations from insurers may need to be more routine to handle internally. Allowing someone to handle it on your behalf and with consistent and assured quality levels can make a significant difference in claim management.

See also: The Pulse Of Medical Coding & Reimbursement: Latest Updates And Insights


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