Hospital Claims Management

Healthcare claims management is the billing, preparation, organization, and submission of medical claims. All hospitals and physician practices need to process claims accurately and submit them to insurance companies for reimbursements. 

But how does it work? Well, there are a series of activities that healthcare providers need to undertake, like: 

• Admitting patients
• Checking their insurance eligibility
• Providing them with the necessary care
• Preparing and submitting a medical claim
• Following up
• Getting paid

 Also Read: How to Notify Patients of Physician Leaving Practice?

A medical claim has all the details of services provided to a patient with a breakdown of the fees. There is no single medical claim definition per se; it simply means a medical bill sent to insurers for review and adjudication.

All the above steps might seem simple but are very complicated and daunting. The entire process can take up to several weeks sometimes. Also, not all claims are approved and paid for the first time. Instead, they are denied and sent back to the providers for modifications or corrections. There can be several reasons for claims denial, like faulty processing, coding mistakes, etc.

Healthcare providers must re-prepare and re-submit these denied claims on time to request reimbursement again. Thus, hospitals also have a denial management strategy to identify errors and respond to denials.

With denial rates rising to 57% and healthcare costs increasing more than ever, you need to take some solid steps to improve claims management processes.

Below, we have enlisted some things your institution or practice can work on:

Assigning Job Roles

Frontend workers usually have jobs, like:

• Helping patients complete the paperwork
• Getting prior authorizations
• Verifying healthcare insurance coverage and eligibility
• Collecting the balance from patients at the time of service, etc.

On the other hand, backend staff deals with claims submission, accounts receivable, claims denial management, and more.

The frontend and backend staff of a hospital are equally responsible for processing error-free claims. However, we often see that the backend staff handles most of the responsibilities in medical claims management.

Thus, most issues are spotted at the latter stage of claims processing by backend workers. You can change that by defining job roles accurately and holding both departments accountable for denials.

Keep Your Patients Updated

Transparent billing, detailed meetings, patient support, etc., are some examples of how you can strengthen patient relationships. Your patients should be your priority, which is why you need to keep in touch with them.

It is not a mandatory requirement of hospital claims management to update patients on their claim statuses. But, constant interactions can help you handle denials better and accelerate approvals.

Effective insurance claims management enables you to update patients promptly and personalize messages. Thus, you can also work on your patient retention strategies simultaneously.

Secure Patients’ Personal Data

There might be a dozen people at your institution who can access patient files effortlessly. However, you need to limit access to only a few members who directly handle your patients’ healthcare, protecting their privacy.

Also, ensure that all your claims management activities are in accordance with PIPEDA regulations. It will help you eradicate data breaches and maintain your brand reputation.

PostGrid’s direct mail services are PIPEDA-compliant. Therefore, if you need to print and mail medical documents to patients or insurers securely, PostGrid is an excellent platform to get started.

 Also Read: PostGrid for Compliance Teams

Follow Up With Insurers

Healthcare providers must make follow-ups an integral aspect of their claims-handling mechanism. Every seven days or 15 days, they should follow up on their submitted claims to increase revenue levels faster.

Also, think of other ways to contact insurers and inquire about your dues. For example, you can set up a triggered campaign to send follow-up letters to insurers weekly as a reminder to complete your reimbursements.

You can combine such mailing campaigns with email and calls to increase impact. In short, you can develop a robust claims management program by using multiple channels.

Outsource Your Claims Management Tasks

If you want to save time, increase efficiency, and process claims in the best way possible, consider employing a claims management company.

By outsourcing, you can free up your employees’ time, cut manual effort, and reduce administrative costs. Plus, you can ensure that everything is completed smoothly and securely.

 Also Read: Proof of Insurance Letter