The type of insurance plan that covers treatment related to workplace injuries and ailments, known as workers’ compensation, provides financial assistance to employers who purchase it. The requirements and documentation for this are unique, necessitating medical billing professionals who are billing claims associated with these plans. They must be aware of the limitations of the plans.
Unique Features of the Workers’ Comp Plans
Workers’ comp claims, unlike other common health insurance plans, are manually processed. Industry standard related to most third-party payers being automatic processing of medical claims via electronic data interchange, workers’ comp medical claims are processed manually. It is necessary to ensure that injury-specific and work-related conditions are being treated under these plans.
The Process of Workers’ Comp
Upon being injured or having contracted a work-related medical condition, the employee will file a claim with the insurance carrier of the employer. A claim number will be assigned; it acts like an insurance ID number for claiming reimbursement. An adjuster will be assigned for the employee too, who authorizes the medical services provided to the employee.
With the relevant information about the employee, the provider’s office takes care of services. The employee’s personal insurance plans will not be involved for the services related to the injury. Nonetheless, non-related services will be billed to the personal insurance of the patient.
Workers’ comp claims may be submitted in the CMS-1500 claim form, similar to other health insurance claims. The adjuster has to review the charges and the supporting documentation for ensuring that medical services are for work-related medical conditions only. Confirming that the charges are appropriate, the adjuster reprises them in line with the carrier’s fee schedule.
Medical billing and coding solutions offered by Numinatrans enables business organizations and agencies to comply with regulatory requirements, while achieving submission of accurate and timely claims.
If you are looking for reliable and effective medical billing solutions, you are welcome to approach us. Log on to http://www.numinatrans.com/services/medical-billing/ for more details.
Revenue generation in any medical practice depends on its efficiency in the medical billing process. Offering reliable medical service being their primary objective, practices need to have sufficient cash flow to make ends meet financially. In this connection, it is imperative that medical practices employ effective strategies for collection of the amount for services provided, failing which may lead to put the practice under jeopardy.
Factors that Influence Practice Revenue
While a well-maintained medical billing strategy ensures healthy revenue cycle and a financially stable practice, there are certain factors that when not cautiously handled, might lead to reduced revenue generation:
Efficient Claims Management: It is imperative that you have an effective claims management apparatus in place – this helps achieve a positive growth of practice revenues
Proper revenue collection: One way of enhancing revenue in practices is ensuring an efficient collection procedure and checking the revenue generated
Managing self-pay Effectively: With changes in insurance plans, a significant amount of patient payments is borne by patients themselves by way of co-pays and deductibles – it is essential to manage these self-pays prudently
Trained and qualified staff: A satisfactory revenue cycle management can be achieved by employing qualified and trained resources
Challenges in Medical Billing Process that Need to be Met
Accurate Patient Information: Failure to gather patient data properly may lead to inaccurate and incomplete information which makes it hard to collect payments
Inaccurate Quotes for Services: Changes in the health insurance setting has resulted in insurance plans having higher deductibles than before – when patients are not informed completely about their payment responsibility, they may be taken aback when they receive medical bill for services provided- the likelihood of their making prompt payment is reduced
Lack of Proper Claims Management: Insurance claim filing is a complex process and keeps continuously evolving – it is essential to make your claims management process efficient
Avoiding Errors in Medical Billing: Billing errors are one of the common causes for claims denial – with changes in codes and regulatory requirements, it is tough avoiding erroneous coding and billing
By making use of latest medical billing software that takes care of updated solutions, or by outsourcing your medical billing task to skilled and experienced medical billing service providers, you may avoid unpleasant eventualities.
Numinatrans is the market leader in providing efficient medical billing solutions to different types of medical practices and medical professionals. We have been offering unmatched medical billing and coding services to global medical organizations since more than a decade. Visit our website www.numinatrans.com for further details.