Clean claim rates of over 95% are frequently attained by providers who automate eligibility and insurance verification. In order to give the billing office enough time to answer any queries prior to the patient visit and enter accurate data into the EHR before a claim is created, IBS HealthNET systems can also conduct batch checks multiple times before the patient visit. This prevents cycles of refused claims and increases revenue.
In order to be able to provide services to patients who are subscribers to the Payer’s plans, physicians and other providers must attest to and enroll in the Payer’s network. The credentialing procedure, in which the Payer confirms the physician’s education, license, experience, certifications, affiliations, malpractice, any adverse clinical occurrences, and training, validates that the physician satisfies the requirements for providing clinical treatment.
Claim Scrubbing & Claim Submission
Before sending the claims to payers, the claims scrubbing or submission procedure entails examining the claim data. To verify the accuracy of the data, we make use of the practice management systems’ capability. Before sending the work to insurance payers, we recognize the rejections and work edits and make the necessary corrections.
Medical Coding & Billing Services
The stagnant reimbursement caused by manual medical coding is caused by a number of problems, including decreased productivity, lower case review rates, and lengthier physician response times. The staff won’t be able to effectively track inquiries and the Diagnostic Related Grouping (DRG) assignment will not be optimized by hand coding. Medical coding manual methods have shortcomings, which artificial intelligence (AI) can fix with its sophisticated automation tools.
It’s common to mix up denial management and rejection management. Rejected Claims are those that, as a result of errors, did not reach the payer’s adjudication system. Billers are required to amend and resubmit their claims. Conversely, denied claims are ones where the payer has made a decision and rejected the payment.
IBS HealthNets’s rapid follow-up services, which make sure you thoroughly understand the causes of delays in accounts receivable and swiftly follow-up with insurance companies and patients, assist healthcare providers in reducing the number of days that accounts are past due.