Efficient Ways To Improve the Claims Process

There are efficient ways to help improve the claims process and potentially streamline the information you receive. In the healthcare industry, claims management is something many overlook and underrate. Poor management systems leave the business struggling to ensure efficiency and accuracy in claims processing.

Improve the Claims Process: The Things To Accomplish

If you’re trying to improve your company’s claims handling, there are some steps that you can take.

Ensure Patient Data Accuracy

One common problem in processing claims is inaccurate patient data. Administrators must code patient information correctly, or else they will code claims improperly. Update patient records after every appointment or conversation so that the claims department has all the information necessary to submit those requests accurately.

Prioritize Training

Staff members responsible for any function of claims management should receive comprehensive training not only when hired but as an ongoing service. Claims handling is an evolving industry with coding changes and best practices changing regularly. Ensure continuing education requirements keep your staff current on the policies and procedures required for their roles.

Streamline Denied Claim Handling

Denied claims are unavoidable. However, you should not let it disrupt your business. If you streamline how your practice handles rejected claims, you can address problems quickly, correct those submissions, and receive the reimbursement requested.

Institute a claims management procedure for assessing each denied claim, including the reason for the denial. Some of the most common claim denials result from miscoding, incomplete information, missing referrals, or insufficient supporting details. Review each denied claim and correct any oversights or errors to reduce your losses.

Establish Quality Control

Many often overlook the value of quality control in claim processing. What many professionals don’t realize is that quality control provides critical information about oversights, errors, and shortcomings of training. Consistent, proactive quality control measures are essential for risk management, reducing costly mistakes that result in denied claims and delayed cash recognition.

Mandate Denial Reporting

Even if you have a procedure for handling denied claims and quality control to reduce them, your senior management should have visibility of those denials and their reasons. This oversight is essential for ensuring that your practice is accountable, accurate, efficient, and honest.

Reviewing the statistics and instances of denied claims can uncover trends with specific staff members or certain types of claim filings. Reporting that reveals these trends will make it easier for senior staff members to address those problems and ensure a more consistent, reliable cash flow.

Don’t let your claims management process falter and leave your practice at risk. The proper procedures, checks, and balances will ensure accurate claims information, comprehensive account handling, and reliable cash flow for your practice. These are some of the most common means for improving your claims handling, but you may also find other areas where your practice can improve.

About Byrnes Agency

At Byrnes Agency, we offer insurance solutions that can be tailored to meet your specific needs. Whether you’re looking for personal policies or commercial coverage, we have the right coverage for you. To learn more about our products, contact us today at one of our two locations.