The law’s main premise is that a payer must reply to a valid claim within a certain amount of time (usually around 30 days for electronic claims).

In order to efficiently use the clean claim rule, your medical billing process must have a tracking system that flags:

• Which insurance firms are covered by your state’s clean claim statute (some are exempt)?
• The date on which your clinic submits each medical claim for the first time;
• Events that bring the clean claim clock to a halt (e.g., an information request from the payer),
• When your practice has responded to payer requests by taking action;
• The date on which you received the final adjudication decision from the payer.

The prospect of carefully tracking all of this data may seem intimidating, but with the right system architecture, it is both achievable and desirable. Your claims will pay faster after you file a few Clean Claim law violation reports. I’ve witnessed cases when payers have contacted solely to reassure the practitioner that claims will be processed swiftly.

Running a trial on a payer that frequently takes more than 30 days to adjudicate claims is one method to quickly get started using the clean claim law. Find a small number of significant claims for this payer that have been open for more than 30 days and run a test with them. This will enable you to understand the foundations of how to file, monitor, and view the results of complaints.

Tips for Getting Your Medical Practice to Have a 95% Clean Claims Rate

How can your medical practice attain a clean claims rate of 95%? Despite the fact that this may appear to be a tall goal, there are several medical billing tactics your medical practice may apply to help increase your clean claims rate – and your entire revenue cycle management!

Keep patient records up to date.

There’s a lot of patient information that can change—and change quickly—from contact information to insurance carriers and more. Patients must check or update their current information before getting treatment, as faulty patient data is a leading source of denied claims. To reduce delays, use exact documentation to help check patient information ahead of time, and have patients update their paperwork at every visit (or even sooner with automated reminders).

Prior to the date of service, double-check your eligibility.

Patients that come to your office on a regular basis are known as established patients. They’re also the patients who your employees might presume haven’t had any recent insurance changes. Most denied claims, however, are generally the result of outdated established patient insurance information. Collecting and confirming every patient’s primary, secondary, and even tertiary insurance at least five days before their scheduled service is one step toward a 95 percent clean claims rate.

It’s also vital to double-check any in- or out-of-network benefits, copays, or deductibles.

Keep in mind the deadlines for filing insurance claims.

In most cases, filing a claim necessitates submitting it within a specific time frame. Any claim submitted outside of the window will result in a higher number of refused claims.

 If you want your practice to have a near-perfect clean claim ratio, one of the best ways to do so is to pay attention to claim deadlines and handle any concerns with patient coverage prior to their date of service so the claim is not submitted late. Aim for authorization between three and five days prior to service as a best practice.

Even the cleanest, most well-documented claim can often take weeks, if not months, to process. In the meantime, the practice loses out on revenue. This is why many of them opt to have their billing handled by a third party. Ultimately, WWS contributes to a smooth, continuous flow of revenue that benefits the bottom line of health practices. Contact WWS today to learn more.

It’s clear that the ACA has impacted EMS Claims Management and reimbursement in many ways, of which, these are only a few.

More people than ever have health insurance under the ACA and, of those, many have Medicaid. With this shift, the average per run reimbursement is lower for many EMS agencies, and the climbing deductibles are making it even more challenging to collect from patients.

To keep pace with changes to health care reimbursement, EMS organisations need to reduce inefficiency in revenue cycle management.

The days of Cadillac health care coverage are over

Although there may be more people who have health care, reimbursement remains a challenge due to the high out-of-pocket expenses like deductibles and coinsurance. The days of Cadillac coverage are over.

This means managing accounts receivable (A/R) is extremely important for EMS agencies. For A/R to be done right, it needs to be an automated process that manages invoicing, statements, warning letters, and collections flawlessly. On top of this, it needs to safeguard the standard for how each EMS agency handles hardship and bad debt.

A couple of health care reimbursement challenges and changes on the horizon for EMS include:

• Risk-based models: Providers working with public and private payers can expect to face either lower fee-for-service rates or more demands to take risks, such as agreeing to care for a designated population for a set payment. EMS agency leaders should consider seeking partners who can help them increase efficiencies and avoid taking on risks that are outside of their control.
• Supplier vs. provider: There are ongoing efforts to shift ambulance services from suppliers of medical transportation to providers of health care which could lead to increased quality reporting, required standards of care, and value-based payments.

Tips for managing pending health care claim reimbursement

Here are a few tips that may help your EMS agency manage pending claim reimbursement.

Establish clear payment plan policies. 

Establish and manage payment plan policies as part of your pending bills review. Unlike medical providers, EMS agencies are unable to ask for or collect copay and deductibles before rendering service. A formal internal collection process is critical to financial health.

Determine if negotiating payment will work for you. 

Some payment is better than no payment. Create scripts that billers can use when communicating with patients regarding payment. Test several different script versions. Measure which ones are the most successful and be sure to track outcomes.

Avoid sending outstanding A/R to collections. 

Often billers resort too quickly to the services of a collection agency and end up feeling the choice was a mistake. Evaluate your current ageing process and determine if changes are worth making. Is your warning letter text effective? Would sending warning letters on different coloured paper have more impact? Would adding another statement cycle improve results? 

Even with helpful tips in hand and EMS billing best practices on your side, sometimes the best way to adapt to health care reform and industry changes is to invest in a cloud-based EMS software that can help you with all of your needs and help you with industry pain points like unwanted policy change and compliance regulations.

Did you know? Our online EMS Billing Services can help decrease bad debt and increase revenue by improving claims processing and pursuing collections to help you receive all reimbursement you are contractually owed.

Our EMS Billing services are designed to improve the quality of documentation needed to get paid quickly. Plus, our EMS billing experts, who have decades of EMS billing experience, can help keep EMS providers compliant.

Read up! Feel free by writing me at support@wonderws.com or Schedule a free live demo http://localhost/main-site-update/live-demo/ for any assistance.