Navigating the Tricky World of the Health Care Provider

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If you are a health-care provider you will need to tread cautiously when it comes time to complete and submit insurance paperwork. Health insurance companies employ whole departments of workers to go through every submission with a fine-toothed comb, and if problems are found the entire claim could be denied. Submitting incorrectly coded or incomplete invoices can result in a great deal of wasted effort and wasted money.

Get Your Patient's Information Up-Front

One of the most effective things doctors, dentists and other providers of medical services can do is to get the insurance information for new patients before the patient even arrives in the office. Every time a new patient calls to make an initial appointment, the staff member taking the call should ask for all relevant insurance information, including the plan number, the group number and the member number. As soon as the caller has scheduled the initial appointment, the staff should call the insurance company to verify coverage. That way, if any problems with coverage are found, there will be time to contact the patient and gather additional information.

Document Everything

Documentation is at the heart of the health-care industry, and it is an essential part of the health insurance world as well. If there is a question about the medical necessity of a particular test or procedure, documentation can provide the justification the health insurer will need to pay the claim. If that documentation is not available the provider will have no basis to file an appeal, and as a result that provider may be out the money for that test or procedure.

Hire a Billing Specialist

These days medical billing is a specialty unto itself, and the process of filling out medical claim forms and getting them paid has become quite complicated. Without the right codes, health insurers and government agencies are likely to deny the claim, so it is vital that the code on the claim match the diagnosis on the medical paperwork. Hiring a medical billing specialist or a medical billing company, such as Bill Medical, is one of the best ways for providers to protect themselves and ensure that every claim is paid in full and paid on time.

The world of health care is always changing and evolving, and it is up to every provider to take a look at this changing situation and adapt their policies and practices as needed. By staying on the cutting edge of those changes companies can protect themselves — and their patients —no matter how quickly the health care system changes gears.


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