Health care claims process involves different types of billing methods. It normally takes 15 days for receiving payment; if your insurance payments average a TAT of more than 30 days from sending the bill, you need to develop a claim follow-up process.
How the Medical Insurance Company Works
Most of the managed care contracts allow insurance companies to take 30 days time for responding to claims without interest penalty. They may take longer for paying too. It is essential to develop effective collections policy for medical care claims to guarantee quick payment. Practice accounts receivable days can be certainly improved by following up on the status of health care claims.
Reasons that Necessitate Claims Follow-up
Depending on the billing method, health care claims may be paid between 15 and 30 days normally. It is not required that insurance carriers must pay up within this time frame though. Following are the major four reasons why medical claims have to be followed up:
Claim not received at all
o One of the primary reasons for non-payment is the claim never being received – this mainly happens when paper claims are missed or lost mysteriously. Sending electronic claims is the best remedy to counter this problem. Checking whether the claim has been received properly and if not, taking action to send out another claim sooner is essential.
o By calling the insurance providers, you will be able to understand the reasons for denial even before collecting the paper denial through mail. Resubmitting the claim after correcting the relevant factors shortens the TAT for payment
Claims Put on Hold for want of Information
o In case additional information is required from the patient, health care claims may sometime be kept aside for further data. Patients will be intimated by insurance companies to this effect, yet, it is better for collectors to keep in touch with patients so that unwanted delay may be avoided
Underpayment / Lower Reimbursement than Contracted fee schedule
o In the event of the insurance company paying a claim, but the amount is found to be lower than the contracted fee schedule, the issue needs special attention – revising billed amount for achieving maximum value on contracted payments need to be done
Numinatrans is equipped with a team of billing experts who are capable of analyzing reasons for claim denial, tracking common denominators, and identifying and eliminating the weak links. We ensure that our denial management support and collections service help reduce delayed and rejected claims considerably.
For further details, visit our website www.numinatrans.com
Mounting pressure is being felt by small medical practices universally. This leads to making them join hospital staff, join larger groups, or even just fade away. The Medicare Access & CHIP Reauthorization Act of 2015 is quoted to be one of the crucial causes for this hardship and the struggle to survive. This new law dictates how physicians are to be paid by Medicare!
Basics of MACRA
The Medicare Access & CHIP Reauthorization Act (MACRA) of 2015 is considered to be an attempt aimed at changing the health care in such a way that payment toward services is based on quality of service rather than quantity. It replaces the earlier system of reimbursement that was not satisfactory to physicians. Doing away with the supposedly wasteful spending of over a third of the whole health care budget, this new system is being received well. There are risks involved, however.
How does MACRA work?
There are two broad payment systems under MACRA, out of which physicians need to choose one. The first one is associated with doctors exceeding the standards of care quality and it offers a bonus of up to 4% on the Medicare reimbursements. This is expected to go up to 9% by the year 2022. Those physicians who score below the standards set will have to face penalties.
The second method, called Alternative Payment Models (APM), determines care quality through the physician in the organization itself. In this, doctors receive an annual bonus of 5% from 2019 through 2024. The physicians in the facilities will continue getting payment adjustments from 2026 onwards.
The intention behind pushing physicians into larger organizations is the view that better care delivery will be possible at lower cost. This is made possible as they have better revenue cycle management processes, more resources in hand, and expenses may be brought down by seeing increased number of patients. The flip side is that it leads to the end of smaller medical practices with one or two physicians.
How would be the future of MACRA?
One issue with MACRA is it penalizes doctors for limiting the number of Medicare patients they see or avoiding Medicare entirely. Moreover, practices in rural areas may not be able to support larger physician practices. It would lead those in rural areas to leave for joining hospital staff in cities or joining larger organizations.
Reporting physician care to government involves the burden of additional layer of paperwork that costs hefty amounts of money. There is no system in place as of now, necessitating creating one – adding to the general burden in health care. Making this law functional will involve considerable efforts and the impacts will be realized after years.
MACRA is no doubt of controversial nature. It might lead to the end of small physician practices as being perceived presently. However, concerns expressed by various doctors will be addressed and the necessary modifications are likely to be carried out. MACRA is expected to have a telling impact over health care of Medicare patients.