Master Your Claim Submission Process in 7 Easy Steps

1. MASTER YOUR CLAIM SUBMISSION PROCESS IN 7 EASY STEPS www.capminds.com

2. Introduction • To be successful with the medical billing process, the claims have to be monitored & revised, the reason for denials have to be correctly identified, and necessary action to be taken before getting started with the process. 

3. What Is Claim Submission? • The claim submission is defined as the process of determining the amount of reimbursement that the healthcare provider will receive after the insurance firm clears all the dues. If you submit clean claims, it means the claim spends minimum time in accounts receivable on the payer’s side, resulting in faster payments.

4. Steps To Achieve Clean Claim Submission Rate

5. 1. Ensure updated patient information on claims • Updated patient records are very essential for the quality healthcare delivery for your patients. • The maintenance of accurate and up-to-date patient information and health records can make all the difference to the outcome. • The information such as insurance policy data, patient demographics, and medical information should be thoroughly verified by your practice staff for submission of claims.

6. 2. Verify patient eligibility earlier • Verifying patient eligibility at least two days before the DOS (Date Of Service) will help in better claim submission and lesser claim denials. • The information need to be verified in this step includes co-pays, deductibles, policy effective dates, in-network/ out-of-network benefits, and other requirements.

7. 3. Manage pre-authorization requirements • Reduction in prior authorization-related denials ensures that there are reduced claim denials and improved cash flow. • This should be done at least 5 days before the DOS. • The information need to be verified - the type of procedure, checking which procedure requires prior authorization, and verifying if that is procedure is covered under the patient plan.

8. 4. Remain updated with medical coding regulations • Outsourcing the claim submission process to the top medical billing companies will help you to stay up to date on all medical coding changes, ensuring your claims are coded correctly before submission.  • The healthcare practices can also make use of the automation process called electronic claim submission by implementing the best medical billing software to process claims faster.

9. 5. Know your payers & ensure correct modifier usage • If their software does not recognize a modifier correctly, then it may lead to rejected claims. • So it is better to understand what payers will cover and what they won’t. • The information you need to verify includes the application of the correct modifier and appending the modifier on the correct procedure.

10. 6. Perform quality checks to ensure clean claims • It is always advisable to perform quality checks to ensure the clean submission of claims in the medical billing process. • The information to be verified includes demographic errors, medical coding errors, and errors that occur during the process of submission.

11. 7. Maintain proper medical documentation • A well-documented medical record can facilitate effective RCM and reduce any hassles related to claim to process and ensure reimbursement. • Here, the information that needs to be verified includes patient medication history, procedure documentation, case history, and other medical documents for faster claim processing

12. Conclusion • As we all know clean claims lead to faster reimbursement, what is the best solution to achieve it? • Outsourcing the submission of claims to the best medical billing service provider like CapMinds will increase your clean claim rate, reduce your overhead costs and ultimately improve your practice revenue.

13. Read More About Medical Billing & EHR @ CapMinds Healthcare Blog

14. CapMinds Medical Billing Services Contact us CapMinds Technologies 42240 Mason Ridge Ct, Brambleton, VA 20148 +1 571.213.3245 info@capminds.com https://www.capminds.com