7 things of all practice you must remember about the billing cycle

The billing and collection process can be long and complex. It helps if you can identify and avoid the most common mistakes when preparing a claim. Here I mention 7 things that all practice should remember about the billing cycle:

Medical Plans:

Each medical office must have accessible a list of all insurers with which it has a contract. The list must include all the necessary contact information such as: address, telephone numbers, email address, contact person or service representative in your area, and provider information. You must also have all the documents up to date with each insurer to maintain active contracting.

Time to invoice:

Each insurer has its own rules and time limits for submitting a claim. It is hard to remember all the rules of all insurers; For this reason, it is recommended to keep them in writing and accessible to avoid sending claims outside the time limit. Staying organized allows you to reduce the risk of not being able to claim, adjust or appeal the same.

Pre authorizations and referrals:

There are certain coverage of each medical plan that requires preauthorization and referrals for certain treatments and procedures. To bill, you must know what those covers are and the process to follow. In addition, you must know and understand the information and documents you need to process that information with each medical plan. If in doubt, it is very important to maintain direct information with the service department to the provider of each medical plan.

Frequency:

Each medical plan allows a certain amount of frequency that a service, procedure and / or treatment can be made to the insured per policy year, depending on their coverage. You must also know the rules of multiple procedures (“bundled”). If in doubt, it is very important to maintain direct information with the service department to the provider of each medical plan.

Submission of claims:

The method to submit a claim to the medical plan varies by company; so, you must have full knowledge of the stipulations of each contract. Ensure that the invoices are submitted electronically, to paper and for coordination of benefits. Also, make sure that each claim has the proper documents required for proper processing. It is important to keep in mind that all adjustments are worked immediately since the time is much shorter than for a new claim.

Payment requirements:

Insurers are required to submit payment of claims sent to the plan within 50 days and in some of them within 30 days; but it is not always the case. Must be in constant pursuit to be able to claim those invoices that the plan does not liquidate within the term established.

Appeals:

As mentioned, every insurer has its regulations and limits to process claims. However, if there are claims that have not been settled within the term limits for each insurer, they must be submitted by the appellate process.

The billing cycle is very complex, with many variants and processes to follow. The best way to ensure that everything is handled correctly from the beginning to the end, is to have experts in the field. Please, feel free to contact us at any time for more information and to know how you can have a more efficient administration of your claims.

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