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.
]]>Training staff to complete this task can help boost revenue at time of service and save time on the back end. That means your front office has to be on the ball to obtain and accurately record all eligibility information.
The front desk staff is responsible for checking in patients and should make it a priority to check the patient’s insurance carrier to ensure the information on the card is up to date and correct for that date of service.
Your staff is responsible for determining each patient’s insurance eligibility, including:
- Coinsurance & Copay
- Benefits Cap
- Deductible
- Whether the payer requires specialized forms or additional documentation
- Where to send the claim.
Insurance Re verification:
Your front office staff also should re-verify the patient insurance when appropriate. For example, If your patient gets a new job, he or she will have new benefits and that means you’ve got to complete a new eligibility check. But benefit details like Deductibles, Copays, Coinsurances, and type of coverage can change at the beginning of the year and/or month. So, if you haven’t seen the patient for a while, or if you recently flipped a page on the wall calendar, then it’s time to re-verify insurance.
Insurance Verification Policy Period:
By checking benefits within a short window of time before the patient’s appointment, you’ll help ensure patients are clued in to their financial obligation so collecting payment is easier. Consider implementing a 72-hour verification period policy for your front office and it saves you from no-shows and day of cancellations due to high deductibles.
Your office staff should confirm whether the patient’s plan will consider the specialist an in network or out of network provider. This is vital, because it will affect who is responsible for the main part of the bill. The primary advantage of determining that the physician is an in network provider is to allow the physician to receive a negotiated or discounted rate for the services, and the patient’s insurance generally picks up a larger portion of the bill.
For Example: If the physician is an out of network provider, then the patient will need to pay their portion of the bill at the time of the visit.
WWS has great expertise in handling Insurance Eligibility verification with all types of payers across States, hence we can help you to lower the denials and increase reimbursement http://localhost/main-site-update/insurance-eligibility-verification-services/
Auto Insurance Eligibility Verification:
If you work with an auto accident patients, don’t forget to verify eligibility with their auto insurance companies, too. You can even include a separate section for it on your patient intake forms, like Physical Therapy and Sports Medicine Center.
Just as you would with a regular health insurance company, verify that the patient is covered and confirm that the patient is approved for physical therapy visits. You should obtain proof of authorisation and provide the auto insurance company with any necessary authorisation forms before providing any kind of service.
“Insurance Eligibility verification may seem like a run of the mill task, but without performing this step and collecting all the pertinent information, your claim is dead in the water. With a capable and confident front office staff, you can greatly reduce your clinic’s number of underpaid claims, denied claims, and delinquent accounts and dramatically improve your bottom line”.
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