Billers work hard to collect the reimbursements to which clinicians are entitled and healthcare insurance providers work equally hard to delay or reduce those payments.

It requires more data, phone calls and effort on the part of billers to collect even basic amounts. In this revealing article, Nitin Chhoda examines the insurance game and how to be on the winning side.

Insurance companies are in business to make money. When they make reimbursements, they view it as losing money.

As a result, insurance companies have reduced the amounts they pay medical providers for services, have become inventive at delaying reimbursements, and adept at utilizing a variety of techniques to deny payments.

EMR Assistance

Reasons for rejections come in many forms and electronic medical record (EMR) software is the first step in combating short or rejected payments. The software systems transmit claims electronically, ensuring they arrive at clearinghouses promptly and provide billers with an ongoing status record of each claim submitted.

EMRs can detect potential problems that could result in a rejection, allowing billers to submit clean claims that are processed quickly. The systems aid billers in submitting the appropriate forms to the correct clearinghouse and alert billers when a claim has been accepted or rejected. EMRs provide billers with a complete system for claim management.

Learning the Ropes

The techniques used by insurance companies to deny claims or pay at lesser rates are designed to keep money in their coffers for as long as possible. Quick submissions combined with meticulous documentation are essential when submitting claims and disputing rejections.

Collecting full and timely payments is much like a cat and mouse game, but billers that learn the “rules” are able to collect reimbursements quickly and cleanly that requires a minimum of follow-up.

Winning the Insurance Game

Dealing with insurance companies isn’t for the faint of heart. Denials can be issued for legitimate reasons, such as using the wrong form, not including sufficient documentation, a clerical error or a glitch in clearinghouse software. Organization and quick attention to denials often result in a successful conclusion.

Billers must submit claims within 72 hours whenever possible. If the problem is insufficient payment, an error can be corrected and the claim resubmitted. It’s important that the payer is aware that the claim isn’t a duplicate.

Submit documentation to specify what the error was and the correction. Another beneficial tactic is to submit claims ranked by charges and don’t include documentation unless asked. The needed information is included in the claim.

If attempts to rectify the problem are met with silence or delays, make the patient an ally. Inform the client and let him/her take the battle to their insurance company for a quick resolution.

Policy holders expect their insurance company to pay for appropriate expenses and not leave them holding the bag. Unhappy customers talk to others and insurance companies don’t want to lose clients.

Quick medical billing claim submissions, EMRs and enlisting the assistance of patients are legitimate means of winning the reimbursement game with insurance companies that procrastinate and underpay. In most situations, the payer holds all the cards, but billers can turn the tables and make the payer’s pain the clinician’s gain.

Practitioners of the medical arts are always seeking ways to reduce costs while continuing to provide the best level of patient care possible.

Three ways that practices can accomplish this is by contracting with the best payers, utilizing clearinghouses to process claims, and implementing an integrated electronic medical record (EMR) system. Nitin Chhoda examines the advantages and savings for clinicians in this informative new article.

Millions of reimbursement claims are transmitted digitally each day via EMR technology. They arrive at their destinations in real time and each is documented by one of several clearinghouses located throughout the nation.

Technological advances have done away with the need for postage stamps, paper claims and waiting weeks for approval or denials.

Secure Transmission

Electronic data interchange (EDI) allows practices to transmit reimbursement requests and supporting documentation to clearinghouses in a secure format that meets HIPAA requirements. It’s part of the abilities inherent in EMRs.

Billers can verify electronically that clients have met their responsibilities for any co-pays to help speed the claim along.

Destination Locations

Practitioners contract with insurance companies for payment and all submissions are sent to a specific clearinghouse where they’re scrubbed for any errors or mistakes. Clearinghouses handle a multitude of claims each day and clean claims are forwarded to the appropriate insurance company for payment. Clearinghouses and billers work together to meet the specific formatting requirements of each payer.

Clearinghouses deal with multiple medical providers and insurance companies at once, eliminating the need to bill each insurance company individually. Some charge flat fees or a fee per transaction for claims that are processed. The benefits far outweigh the costs, providing clinicians with a quick and reliable way to transmit claims, verify receipt of those claims, track their status and monitor payments.

Collecting Payments

Working with clearinghouses ensures that reimbursement claims are dealt with quickly for faster payment to physicians. Reimbursements can be electronically transferred to practice accounts in as little as 10 days.

Medical billing team and practitioners should keep in mind that even after a claim has been scrubbed at the clearinghouse it may still be rejected by the insurance company.

It’s the job of insurance carriers to find ways to deny claims. It’s how they make money. When a dispute arises, EDI allows practitioners to quickly discover why a claim was rejected and provide any additional documentation.

Billers can refer to the contract terms between the clinician and the payer and initiate communications to rectify any problems.

Clearinghouses work with multiple payers and millions of claims each week, speeding reimbursements on their way to their appropriate destination, saving practitioners time and money. They assist in verifying and sorting claims, allowing clinicians to collect reimbursements quicker than ever before and are an essential element in the payment process.