Handling medical insurance firms is a big headache for medical professionals like doctors and health care professionals who have set up their own business. Like any other business, the healthcare and medical service related businesses follow the same basic rules of maintaining a smooth flow of finances for sustaining the company and making it grow. It can become a challenging task because unlike other businesses that deal directly with customers in matters related to billing, payments, and collections, the medical professionals engaged in practice has to deal with insurance companies for collecting payments. Unless you are an expert in accounts as well as well versed in dealing with medical insurance companies, you can never dream of increasing profits. Moreover, this is what a medical accounts receivable service provider can do for you.
Insurance claim denials
The main threat to accounts receivables come from insurance claim denials that drive medical professionals to seek expert services well conversant in dealing with it. The company that provides services in managing accounts would conduct healthcare accounts receivable management reviews to ascertain the extent of cash hold up arising from insurance companies refusing to admit claims. The majority of problems in cash flow stem from revenue lost due to inadmissible insurance claims and the company that manages the accounts target these areas for providing remedial measures.
Reasons for claim denials
A proper billing system is necessary to ensure that all bills raised for providing medical services conform to the guidelines of medical insurance companies. Insurance companies are too fussy about bills and ready to strike down claims on the slightest deviations. The outsourcing company that handles accounts receivables is well aware of the expectations of insurance companies and knows the possible grounds of claim refusal.
The most prominent reasons for denial are duplicate claims and claims pertaining to services that do not qualify for claims. Also, there are errors in billing like wrong quantities, improper placement or missing name of the physician, incorrect bill amount and inaccurate codes related to Current Procedural Terminology.
On analyzing the cases of refusal, it comes to light that incorrect or incomplete data entry and inaccurate medical billing are the two broad reasons for claim denial by medical insurance companies.
Addressing the causes
From the above, one thing that comes very clear is that the problems mainly arise from improper billing, which if corrected can bring down the instances of claim refusal. The outsourcing company, quite understandably, take steps to streamline the billing process which in turn would help to increase revenues. When revenue flow becomes steady, cash flow becomes smooth, and it helps to increase profits and make the business grow. Besides handling issues related to outstanding claims, another aspect that puts stress on accounts receivables is delayed collections, which the outsourcing company also takes care of.
Clean bill submission that leads to smooth processing of claims holds the key to successfully managing accounts receivables. Also, stringent follow up of the accounts receivables ensure complete financial stability that every business look for.