Skip to main content

5 Ways To Improve Your Medical Claims Reimbursements

September 9, 2013
medical claims reimbursements

Every practice strives to not only provide top-level patient care but also maximize their medical claims reimbursements. Denied claims are one of the biggest reasons for loss of revenues across all spectrums of practices, and will likely increase once the new and more complex ICD-10 codes are fully implemented. Having a trained, experienced billing staff is one of the best defenses against denied claims; however, there are other ways practices can lose revenue. Here are five mistakes that can cost you and what do about them:

Problem#1: Your claims have been repeatedly denied due to mistakes by your billing and coding staff whose training and experience is insufficient to correctly code and bill clean claims.

Solution: As the new ICD-10 codes go into effect, this is more likely to become a problem. A retraining or refresher session may be in order for your coders and billers whose knowledge is insufficient to send out clean claims. Your office should have regularly-scheduled training meetings to update staff on the latest billing and coding changes as they occur to ensure that billing staff all have the same levels of training and access to correct billing and coding information.

For more information about ICD-10 training programs, M-Scribe Technologies, LLC, a leader in medical billing, coding and documentation services, offers ICD-10 training webinars to bring your staff up to date with the latest changes in coding. Increasing your practice’s billing accuracy will result in an increase in your reimbursement rate.

Problem #2: Your claims are being denied due to insufficient documentation proving medical necessity; this is especially important for practices with a high number of Medicare patients. Other companies require pre-authorization by the insurance company or a referral from a primary care physician (CPC).

Solution: Healthcare providers need to thoroughly and accurately document all procedures, diagnoses and other findings for each patient. Incorrect information will cause a claim to be denied, and valuable time lost filing a corrected claim.

Be sure to have any required authorizations and referrals on file at the time of the patient’s visit for reimbursement.

Problem #3: Some expenses incurred by certain healthcare providers for expenses in the process of diagnosing and treating patients may be difficult to file correctly for reimbursement, particularly with when treating Medicare and Medicaid patients.

Solution: The Centers for Medicare and Medicaid Services (CMS) has proposed new rules that can positively affect 2014 reimbursement for certain providers. Some of these rules, for example, include proposals in increasing payment for ASCs and HOPDs, based on the type of services offered.

Problem #4: Duplicate claims are less common these days thanks to more practices using electronic billing but mistakes still happen, such as entering the same date or duplicate charges on the same claim form.

Solution: It is important for billing and coding staff to take the time to carefully review and ‘proofread’ all claims before they go out the door or click and send. Providers should ensure that billing and coding staff have adequate time and manpower to process claims correctly.

Problem 5: Although trained and/ or experienced, billing and coding staff experience difficulty in keeping up with the claims workload while maintaining a high degree of accuracy in processing claims.

Solution: This is a common problem in many busy practices, especially with over-worked staff and will likely worsen with the implementation of ICD-10. In this situation, working with an experienced vendor, such as M-Scribe Medical Billing Services can provide accurate prompt EMR services as well as promise full compliance with the latest regulations, thus ensuring higher rates of reimbursement and boosting revenues. Call us at 888-727-4234 today.




Image courtesy of

Get the Latest RCM News Delivered

Receive practical tips on medical billing and breaking news on RCM in your inbox.

Get in Touch