Master Your Claim Submission Process in 7 Easy Steps

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MASTER YOUR CLAIM SUBMISSION PROCESS IN 7 EASY
STEPS

• www.capminds.com

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Introduction

• To be successful with the medical billing
  process, the claims have to be monitored
  revised, the reason for denials have to be
  correctly identified, and necessary action to be
  taken before getting started with the process. 

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What Is Claim Submission?

• The claim submission is defined as the process of
  determining the amount of reimbursement that the
  healthcare provider will receive after the
  insurance firm clears all the dues. If you submit
  clean claims, it means the claim spends minimum
  time in accounts receivable on the payers side,
  resulting in faster payments.

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Steps To Achieve Clean Claim Submission Rate
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1. Ensure updated patient information on claims

• Updated patient records are very essential for
  the quality healthcare delivery for your
  patients.
• The maintenance of accurate and up-to-date
  patient information and health records can make
  all the difference to the outcome.
• The information such as insurance policy data,
  patient demographics, and medical information
  should be thoroughly verified by your practice
  staff for submission of claims.

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2. Verify patient eligibility earlier

• Verifying patient eligibility at least two days
  before the DOS (Date Of Service) will help in
  better claim submission and lesser claim denials.
  
• The information need to be verified in this step
  includes co-pays, deductibles, policy effective
  dates, in-network/ out-of-network benefits, and
  other requirements.

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3. Manage pre-authorization requirements

• Reduction in prior authorization-related denials
  ensures that there are reduced claim denials and
  improved cash flow.
• This should be done at least 5 days before the
  DOS.
• The information need to be verified - the type of
  procedure, checking which procedure requires
  prior authorization, and verifying if that is
  procedure is covered under the patient plan.

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4. Remain updated with medical coding regulations

• Outsourcing the claim submission process to the
  top medical billing companies will help you to
  stay up to date on all medical coding changes,
  ensuring your claims are coded correctly before
  submission. 
• The healthcare practices can also make use of the
  automation process called electronic claim
  submission by implementing the best medical
  billing software to process claims faster.

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5. Know your payers ensure correct modifier
usage

• If their software does not recognize a modifier
  correctly, then it may lead to rejected claims.
• So it is better to understand what payers will
  cover and what they wont.
• The information you need to verify includes the
  application of the correct modifier and appending
  the modifier on the correct procedure.

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6. Perform quality checks to ensure clean claims

• It is always advisable to perform quality checks
  to ensure the clean submission of claims in the
  medical billing process.
• The information to be verified includes
  demographic errors, medical coding errors, and
  errors that occur during the process of
  submission.

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7. Maintain proper medical documentation

• A well-documented medical record can facilitate
  effective RCM and reduce any hassles related to
  claim to process and ensure reimbursement.
• Here, the information that needs to be verified
  includes patient medication history, procedure
  documentation, case history, and other medical
  documents for faster claim processing

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Conclusion

• As we all know clean claims lead to faster
  reimbursement, what is the best solution to
  achieve it?
• Outsourcing the submission of claims to the best
  medical billing service provider
  like CapMinds will increase your clean claim
  rate, reduce your overhead costs and ultimately
  improve your practice revenue.

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• Read More About Medical Billing EHR
• _at_
• CapMinds Healthcare Blog

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CapMinds Medical Billing Services

• Contact us
• CapMinds Technologies
• 42240 Mason Ridge Ct, Brambleton, VA 20148
• 1 571.213.3245
• info_at_capminds.com
• https//www.capminds.com