7 Simple Steps To A Clean Medical Claim Submission Process

A health p[rofessional always struggles with finances if they don’t have a good resource to deal with it. The medical part can be handled by the professional, but the finance part requires understanding how things work in the finance world. That’s why health professionals take help from finance experts and third parties for such services. One such service is G.I Health solutions. 

One of the financial issues faced by health professionals is medical claims. Medical claims can cost you a lot if not tackled properly. But first, you have to understand what a clean medical claim is. 

Clean medical claim submission is a process in which the health professional, to get reimbursement, provides the regulatory authority with a billing plan within a year after the end of services. The billing needs to be clean and clear to get approval. If it’s not, it can delay or sometimes stop the payment of the health professional. Then how can you, as a health professional, claim a clean submission? Well, these steps will help you. 

Check Insurance And Verify It 

When a p[atient walks into your medical facility, you have to check their insurance plan and verify it. Different patients have different plans. Some plans cover a few facilities, and it is important to check if the patient coping with his plans has the coverage of your services or not. 

Another tip is to verify the insurance throughout the service. If patients change the plan or alter it, then the original you might face problems while filing a claim. You should also check the number of visits, covered services, or benefits. Before putting the patient’s profile into the billing software, all verifications and confirmations should be done. 

Double Check The Patient’s Information 

If you don’t want your claim denied, the key is to put accurate information. If the patient is dealing online, verifying personal and insurance information is very important. Maintaining the record, the number of visits, services, and benefits will help you submit a clean claim.

One of the most important things is to complete all the prerequisites before the service., You should check the insurance plan to see if the insurance plan covers your services. Always do the pre-certification if you want a successful claim. Before entering a patient into the billing, always check the insurance plan type. Some people have a primary plan; some have a secondary plan that will affect your claim. The plan type will define the nature and length of the service. The insurance plan will help you see how many days and what treatment the insurance covers. To verify all of this, the basic profile of the patient and its insurance must be correct and double-checked by the billing staff. 

Check Eligibility On Time 

This step is an important one to save yourself from claim rejection. Two days before services, check the eligibility and make sure the insurance company covers the services. Before every appointment, check the services because there are chances that the patient has made changes in their insurance plan. 

This eligibility will help you maintain a steady cash flow and quarrel-free transactions. This step will make your service profitable and make your customer updated about their insurance plans before the appointments and visits. 

Timing Is Everything 

The timing in claiming a clear submission is everything. There are different timelines for different services. Mostly it starts with the service date of 90 days, and some may offer no later than a year. It is crucial to submit the claim on time to get your payment on time. If you delay it, chances are you will not be getting a penny. 

Documentation Should Be Proper 

Nothing will get straight if you don’t have a proper documentation process. Maintaining your billing files and systems and documenting everything will set your record straight. Most of the claims do not get what they filed for because of poor documentation and missing information. 

Know The Upgradation In Coding Regulations 

Medical coding often changes, and the regulations associated with these codes can cost you a lot. The best way is to keep yourself updated with the new medical coding regulations. Submitting incorrect codes will lower your chances of getting a claim, and if you get something, it will not be worth the trouble. 

For a successful claim, know your insurance company’s regulations as well. The general guidelines are the same for all medical insurances. Still, there are types of insurance that vary from company to company, and their rules and regulations also vary from time to time. 

Maintain A Steady Data Sharing System 

Losing data is a widespread reason for claim failure or losing a percentage of it. That’s why maintaining a proper channel for sharing information is very helpful for a successful claim. You can ask your I.T. service provider to maintain a steady flow of data sharing from your practice management system to the electronic health record. This will not only help you maintain your client’s profile but will also help you maintain your billing system. This way, you can avoid data loss possible when entering information manually. 

Conclusion

Medical is undoubtedly a sacred and noble profession, but in the end, it is business. To balance business and your profession, you should take guidance from experts like G.I. Health solutions. Your medical services business needs money to help people improve, so getting successful claims and reimbursement is your ideal situation. 

Follow all of the steps mentioned above to get a successful claim, and you will elevate your business and help people get better. The insurance is to help not only people but also medical practitioners, and that’s why you should be very careful with your claims.