Claims management basically means submitting and collecting claims for the medical services rendered to a patient. The starting point of the process is the collection of information from the patient about his/her personal and insurance details. The process cannot be reckoned as ended unless the healthcare practice receives the appropriate payment. The efficiency of the claims management service process determines the success of the claims.
The Claims Management Process
The process involves the role of each member of the practice. Successful claims management service provides many benefits. First of all, there is the immense financial impact. A process that ensures quick payment will result in reduced administrative costs, often brought about by these time-consuming claims application processes. It also filters down to the relationship the doctor has with the patient. Effective claims management makes the relationship better. Inappropriate payments from the health insurer can cause a negative impact on the relationship and the kind of care given.
How Efficient Claims Management Helps
The other advantages of efficient claims management include improved efficiency of the staff, streamlined process for claims processing, more submissions of clean claims, reduced claim denials, precise payment made by the insurance provider, and so on. But it can be overwhelming for a healthcare practice to handle all kinds of claims submission.
There is a significant number of staff that must be maintained for ensuring accurate claims management. This depends on factors such as the kind of practice, number of doctors employed at the practice, the specialty focus and the kind of online service capabilities the practice possesses. The seriousness of the task demands staff members to be assigned specific tasks for specific purposes.
Why Claims Management Outsourcing is Vital
It is understandably a drain on the healthcare practice’s resources to assign staff exclusively for claims management service. Though it is an important task, claims management is a non-core responsibility, something that will prove to be too intimidating for small practices to handle by themselves. This is where a medical billing and coding company comes in.
A medical billing and coding company caters to all these requirements of healthcare practices. It is familiar with all the AMA and CMS-recommended procedures and can take over claims management tasks for hospitals, nursing homes, rehabilitation centers, and individual physician practices.
Outsourcing claims management ensures that healthcare practices get paid promptly and also that they cut costs and save precious resources.
Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.