Whether you outsource your billing or have a biller in your office you should be able to ask questions that keep you in control of your company at all times. I have been in this business for years have heard many excuses about not being able to get what you are looking for out of your system and most of them are just simply not true.
As a billing company we estimate that at least 80% of the denials we see can be traced back to data entry/accuracy errors. These errors occur on all types of insurance claims.
Here are some examples:
Many providers do not know what a clearinghouse is or how it works. Here is a breakdown of what a clearinghouse is and how it plays a major part in the billing process.
In medical billing, companies that function as intermediaries who forward claim information from healthcare providers to insurance payers are known as clearinghouses. In what is called claims scrubbing, clearinghouses check the claim for errors and verify that it is compatible with the payer software. So, in other words a clearinghouse serves as a middleman; for your claims to get sent from the billing software to the insurance companies electronically.
Once the insurance company has received the claim from the clearinghouse they can process the claim. The claim will either process for payment or process denied for any number of reasons.
Here is what you need to know:
The Patient Summary Form was created for certain UHC plans to provide the insurance company with an explanation for the patient’s visit and confirm the need for treatment. The Patient Summary Form must be submitted via fax or on-line and the timely filing deadline for providing this documentation is 10 days from the date of service.
Failure to timely submit the Patient Summary Form will result in loss of payment. If the claim is denied, an appeal may be filed but payment will only be received from UHC if you provide an “acceptable” explanation; leaving the chances of payment solely up to UHC’s discretion.
There are two options you can use to determine if the patient has a plan with benefits that require a Patient Summary Form. You can either call Optum Health Care Solutions at 1-888-329-5182 or log onto www.myoptumhealthphysicalhealth.com and use the “quick group check” utility located in the "Tools and Resources" section.
It doesn’t take long to check and submitting the form in a timely manner will ensure payment and eliminate the hassle of having to file an appeal. We hope this helps you “ Get Paid Right the First Time ”.
If you have a billing problem you need solved, let us know at 508-422-0233. We can help!
After years of consulting and billing, one of the hottest issues is how to improve patient collections. The responsibility of collecting patient payments is a front desk requirement. While some are great at collecting at time of service, too many find it difficult to ask for money and many do not try, even though they know the payment is the patient’s obligation.