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Enhancing Your Medical Claims Submissions: Strategies for Success

Healthcare systems of every size continue to navigate the complexities of the medical claims submission process. Administrative challenges such as improper coding, incorrect patient information, and outdated processes have contributed to significant stress for providers, payers, and patients alike over the years.

 

By optimizing the medical claims submission process, it minimizes errors and delays, leading to faster claim approvals and payments, which is critical for maintaining the financial health of medical practices and facilities. It also reduces the likelihood of claim denials and rejections, which can be time-consuming and often costly to address. For patients, a streamlined process ensures their claims are handled in a timely manner, reducing out-of-pocket expenses, and improving their overall experience within their healthcare system.

 

Improving the efficiency of the medical claims submission process can be daunting, but here are several strategies providers can use to refine their process, even with limited resources.





Perform Charge Capture Audits

To stay compliant and ensure accurate medical documentation, providers should perform charge capture audits regularly. Charge capture is the process by which providers get paid for the services they deliver, using detailed medical documentation to record patient care, which is then assigned medical codes. These codes are translated into charges for submitting accurate claims to payers. Regular charge capture audits help identify and address weaknesses in the recording process, under-coding deficiencies, and challenges with Electronic Health Record (EHR) technology, ultimately optimizing accuracy, patient safety, and reducing costly rework.


Build a Claims Editing Process

As payer requirements become more complex and continue to evolve, it's crucial for submitted claims to meet each payer’s unique business requirements. Even minor errors or technological gaps can cause a claim to be rejected, leading to rework and payment delays. Building and updating a claims editing process can significantly improve first pass claim submissions.


Establish a Cross-Functional Revenue Integrity Team

To optimize revenue integrity, establish a cross-functional team consisting of areas such as Clinical Documentation Improvement (CDI), medical coding, billing, and accounts management. This team can collaborate to review industry trends, discuss challenges, exchange insights, develop process improvements, and execute action plans. The ultimate goal is to preserve revenue integrity and ensure strong financial performance.

 

Get Access to Medical Claims Submission Expertise

Navigating the complexities of claims submission and other related revenue cycle functions can be cumbersome for healthcare systems who are already up against administrative barriers. A strong partner optimizes existing technology investments of the provider, shares valuable insights, and provides knowledgeable experts who drive reimbursements and reduce administrative costs for long-term success.

 

At Signature Performance, our experience on both the payer and provider sides of the industry allows us to address administrative challenges from multiple perspectives, eliminate communication barriers, and create custom solutions for our clients. We have a team of medical claims editing experts who stay updated on the latest coding and billing changes, payer requirements, and industry trends. Our solutions allow for valuable resources and staff time to be reallocated so more focus can be placed on patient care rather than paperwork.

 

For more information on how you can enhance your medical claims submission process, contact our team today!


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