By: Amanda Hall
Filing medical claims accurately is so important for eyecare providers to ensure timely reimbursement and maintain compliance with regulations. Implementing these few checks and balances in the claims filing process will help prevent errors, reduce denials, and ensure that claims are processed as smoothly as possible. Here are some steps for establishing effective checks and balances.
8 Steps for Effective Medical Claim Filing in Your Eyecare Practice
1. Prioritize Accurate Data Entry: Ensure patient information including address, DOB, and name correctly matches their insurance cards exactly. Also, make sure diagnosis codes, procedure codes, and provider details are entered correctly.
2. Use Verification Tools: Check every patient’s insurance coverage, co-payments, and deductibles using the eligibility verification tool (IVES).
3. Determine Pre-Authorization: Some insurance payers may require a pre-authorization before filing. Obtaining necessary pre-authorizations beforehand helps to avoid claim denials. Determine if an authorization is needed for specific diagnostic testing when a patient’s medical insurance is verified prior to the appointment.
4. Ensure Coding Accuracy: Diagnosis and procedures codes can change annually, so make sure you are training your staff on the updates, and ensure that diagnosis and procedure codes are up-to-date and accurately reflect the services that are provided.
5. Utilize Claim Scrubbing: Use your clearinghouse to help identify errors, catch missing information, incorrect codes, and other common errors before claims are submitted. This helps reduce denials, get you paid quicker, and save time in the long run not having to research why a claim was denied.
6. Implement Internal Audits: Review a sample of claims monthly to check for accuracy and compliance with billing guidelines and to catch recurring errors.
7. Track Denials and Rejections: Monitor claim denials and rejections through your clearinghouse weekly to correct errors and get you paid timely.
8. Confirm Timely Submission: Insurance companies have different timely filing deadlines based on the company and the state. Reviewing insurance accounts receivables monthly will help ensure that all claims have been filed in a timely manner.
By incorporating these steps and tips into your medical claims filing process you can enhance accuracy, reduce the likelihood of denials, and ensure a smooth revenue cycle. Need help running an audit or determining if you are set up for claim filing success in your practice? Contact us for a free consultation to discuss your challenges.