Help Resolving Claim Disputes for Medical Billing
Medical claim rejections and denials are simply a part of medical billing. They are highly common. In fact, it has been noted, that between five to ten percent of health care claims submitted in the US are denied. There is no single guidebook for how to go about resolving claim disputes for medical billing purposes, as each claim submitted is different and has the potential for any number of reasons for rejection. There are, however, many ways resolve a medical claim dispute. The first step in obtaining resolution for a medical claim dispute is to know the precise reason for its denial. This can help point a medial billing specialist in the right direction for obtaining its accurate resolution.
Medical claim disputes are very common and unfortunately, come along with the territory of medical billing. There are several steps a medical billing specialist can take to minimize incurring potential claim disputes. Below are steps that can help a health care practice decrease the amount of medical billing claim disputes:
- File claims on time.
- Code each claim meticulously and accurately.
- Make sure to obtain (when needed) preauthorization forms and that they are valid for the time of service.
- Monitor and track claims from start to finish: this can allow for any mistakes to be caught as early as possible avoiding unnecessary delay of payment.
While these steps will not necessarily eliminate all medical claim disputes, they can help to reduce the frequency with which they may occur.
Suggestions For Resolutions
Medical claim disputes can be resolved but typically have very specified solutions that are only relevant to the claim at hand. For this reason providing widespread resolution suggestions is a bit challenging. There are, however, several general suggestions and straightforward steps a medical billing professional can try when attempting to resolve a claim dispute. Below are some of the recommended suggestions, which can include the following:
- Make sure the services rendered are accurately represented using proper medical codes. Some medical claim denials occur due to inaccurate coding. This can be easily resolved by resubmitting a revised medical claim that includes the correct medical coding.
- Take note that most insurance companies follow a standard set of guidelines, but some have different ways of processing claims. Make sure to be fully informed of their preferences and that claims have been submitted in accordance to the insurance company’s specification. If something was done incorrectly, submit a corrected claim.
- Follow, track, and closely document all correspondences regarding a medical claim. Should a dispute arise, providing all documentation can help in reaching a timely resolution.
- Understand why exactly a claim dispute has occurred. This can provide both parties with the greatest opportunity to come to an equitable and fair resolution.
It is important to keep in mind that medical claims take time to process. Most states in America require insurers to provide an EOB (explanation of benefits) and/ or pay claims within thirty to forty-five days of submission. If a claim has gone unaddressed beyond that timeframe, it is best to check on its status by following-up.
As insurance regulations change, it is imperative that companies understand how each change can affect their practice, in all aspects. Insurance companies are notorious for offering excuses and utilizing loopholes to avoid paying providers what they owe. Accreditations such as CARF and JCAHO are now a common requirement for insurance companies to render payment. These certifications alert the public that a company has been adequately inspected and is considered reputable, meeting the accreditations high standards. The accreditation process can be arduous, requiring a significant amount of time and energy. Our staff offers diverse skills that enable Oracle Billing and Services, Inc. to assist in areas ranging from CARF-Accreditation, Verification of Insurance benefits, Insurance Collection Calls, Drug/Alcohol state licensing, JCAHO-Certification and more. Oracle Billing and Services has extensive experience in assisting companies in the health industry, in understanding the ever-changing regulations as well as providing expert consultation for all areas of operations. Reach out today and schedule an appointment with Oracle Billing and Services via phone at 626-872-7344. We look forward to connecting and helping to bring your company to the next level.