Any physician would be happy to get maximum reimbursements for the service that he/she rendered. But, the present circumstances in the United States demands physicians not only be great healthcare professionals, but also be smart enough to earn maximum reimbursements in medical billing. Now, getting maximum payouts is in the hands of the physician and not just the insurance carrier. Let me list the prime factors that can affect maximum reimbursements for your service.
- Non-participation with insurance carriers: It is inevitable for physicians to get credentialed or become participating with all major insurance carriers. Non-participation with medicare and Medicaid leads to denial whereas other commercial carriers pay lesser than you deserve for the service that you rendered. So, choose physician credentialing for enhanced payout.
- Clinical documentation: In most of the cases of denials or underpayment, improper clinical documentation is a reason. Improper clinical documentation with errors or insufficient documentation can be a cause for processing errors, particularly in medical billing and coding, affecting reimbursements.
- 3. Processing errors: The most important and the difficult to avoid is the processing errors. This includes all errors in processing starting with data entry till the processing of the claims, including patient demographics, coding, charge entry etc., It is essential to keep track of the processing errors and find ways to eliminate/ reduce such errors that can affect payment.
- 4. Healthcare implementations: The U.S. healthcare industry is facing the greatest challenges in the form of healthcare implementations. The approaching deadlines and the efforts required to implement the same is scaring physicians across the United States. Even then, it is essential to follow the suggestions put forth by the government and allied bodies in order to improve the quality of healthcare. The CMS encourages timely healthcare implementations by providing incentives and penalizing for not following the schedule. Therefore, physicians have to be cautious in making necessary Implementations on time to avoid penalty.
- 5. Timely Filing Limit: TFL is a valid point that lays emphasis on timely filing of the claims to insurance carriers. Though the TFL varies for different insurance carriers, failing to submit claims before the TFL will result in the denial of claims by all insurance carriers.
- Failing to appeal for claims: If the genuine claims are denied or underpaid, it is essential to appeal for reconsideration, which provides the possibility of getting the claims accepted or paid better, based on the appeal. Failing to do so is a loss to the practice, affecting the reimbursements.
Ensure that you meet the terms with the above mentioned points to assure maximum reimbursements and improved collections in medical billing. It is also essential that physicians periodically look out for any updates from the government and allied organizations that can affect reimbursements.