It Takes a Team to Produce a Good Claim

The entire practice team plays a vital role, from the receptionist who gathers demographic information, to the nurse and physician who prepare documentation, to the coding, billing, and reimbursement personnel who get the claims out the door.

Look at your internal processes to make sure you are covering all the bases required to produce accurate and effective claims. Be sure to take the following steps: 

  1. Before a new patient sees the doctor, gather all required demographic information regarding the patient and insured party (if not the patient), insurance billing information, and coverage levels. Verify accurate information with established patients at time of service.
  2. For each of the practice's insurance carrier contracts, set up a matrix listing all coverage issues and claims filing requirements. Keep all team members informed regarding the requirements and changes as they occur.
  3. Initiate a timely appeals process to address claims that are not paid appropriately. Maintenance of the carrier matrix will help you quickly identify claims that qualify for appeal.

If your billing and collections efforts are falling short, it may be time to take a good look at your front and back office operations. TMA Practice Consulting can help by conducting a billing and collection assessment of your practice, focusing on your complete billing and collections processes. TMA consultants will review your check-in and check-out procedures, payment policies, record-keeping systems, claims handling procedures, staff roles, and work flow during peak periods, and provide recommendations for improvement.

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