The particular type of insurance covering the expenses involved with treatment of injuries and medical conditions that arise out of jobs is known as workers’ compensation. Differing from other types of medical insurance and having limitations, this type of insurance needs to be handled cautiously.
Fundamentals of Workers’ Compensation Claims
When most of the other health insurance processes have been automated, workers’ compensation claims are still being processes in the manual mode. This is because of the fact that this type of insurance claims necessitates greater supervision and scrutiny for ensuring that the affected claimant has in fact contracted a workplace-related injury and is undergoing injury-based medical treatment. Billing procedure for this type of claim includes the major phases of claim filing, patient treatment, and claim processing.
Major Phases in Workers’ Compensation Claims Process
– Claim Filing: The first step is filing of the claim by the injured employees through their workers’ compensation insurance provider – the employee is given a claim number that acts as the unique ID number; the insurance provider authorizes employee’s treatment and assign the adjuster and reviews the recovery of the employee – CMS-1500 claim form is used for submitting workers’ compensation claims
– Patient Treatment: Upon being authorized by the adjuster for treatment, the employee becomes the patient of the health care provider – services will be billed separately, and not to the employee’s personal medical insurance – a comprehensive plan for treatment is developed
– Claim Processing: After reviewing the charges as per CMS-1500 as well as the relevant progress notes attached, the adjuster confirms that services provided are in line with work-related injury and are authorized according to the treatment plan – unauthorized and unrelated services will not be paid for, but the employee cannot be held liable for the same
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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.