Ways to Achieve a Clean Claim Rate

The processing of claims in Medical Coding and billing denotes the entire procedure of submitting and executing claims. And Submitting a clean claim is a very much significant factor of a successful financially medical practice. The basic features of a clean claim are claims, forms, or fields that are filled up clearly and correctly for processing. Inaccurate and incomplete documentation can delay timely payments and also may lead you to legal hazards.

The General Procedures to Submit for Claiming:

At first, the patient delivers his or her insurance card and fills up a demographic form when they come to the healthcare organization. A demographic form includes some information, such as the Name of the Patient, Date of Birth, Address, Name of the Policyholder, and additional information about the policyholder whether the policyholder is someone other than the patient.

In addition, the patient also has to present a government-issued photo ID so that you can verify the person is the insured member. All providers are responsible to verify the patient’s identity to get free from fraudulent activities.

Secondly, after the preliminary form-filling is complete, the patient gets the services followed by the provider’s documenting the chargeable services.

Thirdly, the coder extracts the billable codes, based on the physician testimonials. Then the coding is sent to the biller and the biller enters the information into the suitable claim form using the billing software.

Fourthly, after that, the software sends the claim to a clearinghouse to send the claim to the appropriate payer for reimbursement or it sends the claim directly to the payer.

Indeed, things may not happen as planned, maybe the claim gets hung up or denied somehow due to incomplete or missing info. If it happens, then try to find out a problem to solve it. Accurate billing and coding can save you from fines or unwanted hazards.

Unwanted hazards mean those problems or troubles which can bring huge loss or disaster to your life.

So, whenever you will try for the best medical billing outsourcer, you should study enough about them and need sincere search and research about to submit denial billing claim for your client. There are a few features you should be more careful about to stay free from any mistake in submitting the denial claim papers.

Filling and submitting the denial claim papers timely

• Identify the Invalid Subscriber
• Non-Covered Services
• Invalid Services
• Bundled Services
• Incorrect Use of Modifiers
• Data Discrepancies

These features are enough to avoid all kinds of mistakes or errors which frequently occur at the time of a Clean Claim Form submission.