Good medical billing practices and procedures are critical to success, but without the proper solutions in place, they become challenging to get right. Far too often small, independent practices become caught up in a cycle of poor cash flow as—without the right partners or tools—their in-house medical coding and billing team become overworked and overwhelmed.
EZClaim works to bring powerful tools to, and make it easy for, small and mid-sized practices and RCM companies to submit clean claims every time easily and efficiently.
Claims that need to be resubmitted drain resources and delay payment as they have to be researched and corrected. There are two ways that unclean claims make their way back to billers:
Denied claims are claims that are processed but not paid by the payer. There are many reasons why a claim may be denied. These could include duplicate claims, uninsured services, missing information, insufficient authorization, late submissions, and other reasons. Your medical billing team must investigate the reason for denial to appeal it.
Rejected claims lack important information or are not in compliance with formatting or data requirements. The payer may not process these claims if the claim contains missing information or incorrect insurance policy numbers. These can be corrected and then resubmitted for processing.
Regardless of whether a claim was rejected or denied, you have a limited time to determine why the claim was not paid and resubmit it.
EZClaim gives you the tools and structure to submit clean claims the first time to avoid rejection in the first place. Your team can take steps at different points in the patient encounter to decrease the chance of a claim being rejected or denied.
Use custom templates and rules to identify common mistakes immediately
It is likely that there are specific billing and coding issues that your team finds continually—this is common in the industry. While many organizations are aware of common billing, code, and denial trends, they don’t have the tools to manage them. EZClaim allows you to create custom rules that review billing and code data, and flag errors for review. Automating as much of the claim review process as possible will ensure your time is used most efficiently.
Use a checklist before each appointment with the patient
Be sure to engage the patient before the appointment to stop potential claim issues from the very beginning—has their insurance or patient information changed recently? Using a scanner to collect patient information makes this process easier. Running an insurance verification is another important step.
Document coding and billing review criteria in a central knowledge base
RCM directors, coders and billers are experts in their industry, but this knowledge is not always documented. To ensure clean claims, there are many billing and coding guidelines that must be referenced. Training and reviewing claims can be difficult due to the constant changes in billing and coding requirements, information specific to your practice and payers, and staff turnover. Having a central place to document policies, procedures, and best practices will allow you to maintain accurate data and make sure that claims are filed correctly. Our partner, Live Compliance, offers solutions to make this easy.
Catch rejections and denials proactively with PM software
With claim status verification features, EZClaim can help you be proactive and catch new rejections as soon as possible. As payers continue to add rejection and denial reasons, EZClaim helps you find out where rejection and denial reason codes are coming from and determine the best way to respond to them.
EZClaim is a leading medical billing and scheduling software provider that combines a best-in-class product, with correspondingly exceptional service and support. For more information, schedule a consultation today, email our experts, or call at 877.650.0904.