Claim Entry and Submission
Clean Claim submission is the backbone of any medical billing process. The higher the rate of successful claim submissions, higher the rate of the revenue.
Claim submission sounds simple but involves an overwhelming amount of attention to detail. Successful billers ensure factors such as patient eligibility, Right insurance, Place of Service, Correct match of ICD-10 and CPTs, Rendering and Billing Providers, Facility where the procedure was performed and last but not the least proper units (in case of Anesthesia, Pain Management, physical & Occupational therapy), and billed amount. If any of above factors are taken lightly will disrupt the revenue cycle completely. Therefore, it is highly recommended to outsource the services of an experienced and seasoned medical billing organization such as Vigilant Medical Billing Services for the timely and accurate submission.
Understanding the basics of claim creation process is not only compulsory for billing staff and outsourcing billing companies but is equally important for Provider and his/her medical staff.
The process of claim creation starts as soon as a patient enters into the office of a physician or health care professional. Patient Demographics such as his Full Name, DOB, Insurance name, Policy ID needs to be properly entered. During the doctor patient consultation, the provider must capture all the procedures performed along with medical notes so Professional coders can properly code procedures and diagnosis so that the medical providers are rightly compensated for their services and efforts.
Majority of the claims are rejected due to mistake in any of the above-mentioned factors which require comprehensive follow up work to identify the issue and resubmit the claim. If done rightly the first time, this step can be avoided which in turn will not only increase the revenue of the Practice but will improve the performance of the Medical Billing Staff/Companies.
We at VMBS take care of this problem by employing our most sophisticated Artificial Intelligence modules which meticulously scrub data and identify mismatched CPTs, diagnosis, modifiers, billed units, and charges thus increasing the revenue by decreasing aging to an astonishing rate.
Our pass rate of claim submission is more than 98% which is a clear testament of the effectiveness of our in-house AI tools.
Our team is capable of handling various billing platforms efficiently. Our Business Intelligence Modules are customizable and can be integrated on any platforms hence creating a second layer of Claims Auditing, and Reporting to help identifying the issues and augment our ability to submit clean claims. These Modules are part of our offered services and are available to all our clients with no additional cost.
We also have an incredible process of self-evaluation within the organization. Every Friday, senior management review the performance KPIs of the employees and conduct professional trainings based on the changing Medicare billing guidelines, NCCI edits, and employee’s performance.