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According to the AMA’s latest findings, commercial health insurers have an average claims processing error rate of 19.3 percent, an increase of two percent compared last year.

National Health Insurer Report Card

“Unacceptable!”  May be the first thought that comes to mind.  While there is absolutely no doubt that insurers have a long way to go to when it comes to reducing error rates to an acceptable level, there is a LOT that healthcare providers and their billing staff can do to improve their collections on other fronts. 

We can back track these problem areas right to the clinic support staff. That could be in the front office, back office billing, or in the case of many small practices, the office manager who is trying to wear these hats and many more in order to keep it all running smoothly.

 An analysis of the National Health Insurer Report Card reveals these target areas to be:

 1)    Lack of patient eligibility continues to be the most frequent reason for denials

2)    Non-payment due to deductibles

3)    Non-covered services, see plan benefits for restrictions

4)    Local Coverage Determination

 Each of these target area can be addressed on the front end—before an insurance claim is ever submitted. 

1)    Patient eligibility, benefits, and deductible information should be obtained by performing a thorough verification of benefits check before the patient is ever checked in for his first appointment.

 2)    Deductibles should be collected in advance.  If there is a question as to exact amount that will be applied to deductible and due from the patient, get a credit card authorization on file so that the card may be pinged as soon as the EOB comes in with the exact amount owed by the patient. This eliminates the cost of mailing statements and ensures timely payment.

 3)    Staff should be familiar with specific payer clinical policies and guidelines regarding common treatments in their clinic, so that patients can be informed of recommended procedures that are not covered by their insurance. The patient may choose to decline the procedure/s or pay in advance. Billing staff should keep front office staff educated and updated in these areas.

 4)    Billing staff should stay on top of Local Coverage Determinations (most commonly used by Medicare) so that items not covered at all or for only specific diagnoses will be readily recognized and addressed before the claim is submitted, thus avoiding unnecessary and unexpected denials and write-offs.

 We often find that provider offices are simply overwhelmed by all that is involved in these target areas when combined with the primary focus of patient care.  If you find that insurance billing and reimbursement has become burdensome for your practice, please feel free to give Healthcare Reimbursement Services a call at 888-211-1118, and let us come up with a plan to get you back to what you do best:  caring for your patients!