The principal challenge that most medical care providers face while claiming reimbursements is the chance of claim rejection and denial by payers. This not only results in financial loss for the hospitals or medical facilities but has the potential to strain their relations with the patients. Repetition of all the work for re-submission of the…

Health insurance denials have become increasingly common, causing significant revenue loss to practices. Denied claims are the claims that practitioners have submitted claims to the best of their abilities but are refused to be paid for by insurance. Health insurance billing can be complex since patients are covered with different coverage plans. Figuring out what…

Medicaid eligibility verification helps healthcare providers in submitting clean claims, thereby avoiding claim re-submission, reducing demographic-related denials, and increasing upfront collections. Verification done in time not only leads to improved medical billing but also paves the path for overall elevated patient satisfaction. Medicaid eligibility verification process should ideally start before offering the clinical services and…

Eligibility check, the first step in the insurance claim process involves verifying the eligibility of patients on multiple criteria that includes (but are not limited to) coverage, benefit options, prior authorization, and pre-existing clauses. The process being complex can lead to errors and eventually cause rumbles in the bottom line. Let’s look at some of…

“Prevention is better than cure”, a 17th Century proverb that has it’s roots in the medical profession is now finding a stronger calling in the same profession albeit for a different reason. Recent reports shows that “claim denials” are on an upward trend putting your cash flows into jeopardy. Quite different from rejection that happens…

Insurance claim denials can become a grave concern if you do not take corrective steps at the earliest. Every denial or rejection will not only impact your revenue cycle severely but also strain your relationship with the patient. Well, this makes it imperative to avoid landing up in such a situation. Let us first understand…

Medical care providers must verify all their patient’s insurance coverages and benefits for each and every visit prior to the treatment.  This practice eliminates chances of error-making during the process of filing for insurance reimbursements. An efficient process of verifying patients’ insurance eligibility goes a long way in improving the insurance payments and minimizing the…

Medical practices must focus on ever changing patient eligibility verification process to identifying the right coverage and providing the best medical care to it’s patient. While the medical fraternity strives at providing appropriate and timely care, billing processes often take a backseat. The complex process of billing, keeping a track of eligibility, and filing (or…

Research suggests ~30% of all claims are denied or rejected on the first submission. The success rate of resubmissions is somewhere between 55% and 98%. Resubmission involves time and effort wastage, and revenue leaks. One of the most effective ways of addressing the challenge of denials and rejections is to have a highly effective Insurance…

One of the most time-consuming yet critically needed requirements of running a hospital or a clinic is verifying/validating a patients’ insurance coverage eligibility. The staff of hospitals and practitioners engaged in the process of billing struggle through loads of work and intense deadlines. Dedicating their efforts to the tedious task of verifying the insurance coverage…