Billing and collecting payments from insurance payers can be a long and complicated process. It helps if you know where issues usually arise, so you can avoid making those same common mistakes. To simplify things, we’re laying out the seven things every practice should remember about medical billing:

1. Insurance Payers: 

   Every medical billing office should have an easily accessible list of all the insurance companies that are contracted with that doctor or facility. The list should include all necessary contact information: claims address, website, and provider information. Keeping organized and knowing which insurance payers are contracted with your office will help to simplify things when you are ready to send claims or receive payment.

2. Timely Filing: 

   Each insurance payer has its own time limits for filing, and it can be difficult to remember the stipulations for each individual company. For instance, Medicare claims should be submitted within one year after the date of service, whereas Cigna only allows 3 months, or 90 days, for participating health care providers to submit claims. United Health Care lists their timely filing limits in the provider agreement so you will need to do some research to find out what their deadline is. Because the deadlines can vary widely based on the insurance payer, it is important for your office to have an organized way to keep track of them. Otherwise you will risk missing important filing deadlines and end up either needing to file an appeal or missing out on receiving payment from a claim.

3. Prior authorization/referrals: 

   Some insurance providers require prior authorization or referrals for certain treatments or procedures. For medical billing, you will need to know which payers require this authorization as well as the process for obtaining authorization. In addition, you’ll need to know and understand the information needed to process that information for each insurance payer since these processes vary from company to company.

4. Frequency: 

   Insurance payers allow different frequencies for specific services or procedures, including the number of procedures allowed and the process for billing multiple procedures for each insurance provider.

5. Claims submission: 

   The method and type of claim needed to submit claims to each insurance provider varies, and you should keep track of each specific provider’s stipulations. Be sure to remember the processes for electronic claims, paper claims, secondary claims, and corrected claims.

6. Payment requirements: 

   Insurance payers are required to submit payment within a specified time frame. Typically this time frame is 30 days, but that is not always the case.  Your payer contract will indicate the payer’s time frame for payment once the claim has been filed. 

7. Appeals:

    As stated above, each insurance company has a timely filing deadline. However, in cases when claims are not resolved right away the claims can stay in accounts receivable for too long and end up failing to make the filing deadline. If this happens, you need to make an appeal based on the insurance payer’s stipulations so that you can file the claim and receive payment.

Medical billing is a complex process with a number of moving pieces. The best way to ensure that everything is handled correctly from start to finish is by utilizing a medical billing expert. Please feel free to contact us at any time for more information on how to make sure your medical billing is an effective and efficient process.

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