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5 easy Tips to Resolve Billing Issues of Healthcare Billing Companies

Healthcare Billing Companies aims to resolve Billing Problems

For Healthcare Billing Companies, resolving billing issues and denial management are significant components to concentrate on exponential revenue growth.

Submitted claims will have to meet many challenges until the claims are cleared for the payments.

By following few tips, healthcare billing companies can eradicate billing problems and experience seamless flow of revenue in future.

5 easy Tips to Resolve Billing Issues of Healthcare Billing Companies:

  1. Billing Disputes
  2. Eligibility and Benefits
  3. Claim Denials
  4. Internal Appeal
  5. Independent Review


  1. Billing Disputes:

  • Medical billing is complex and often confusing. Healthcare Billing Companies may receive bills for services that they should have been covered or assumed as already paid.
  • Each health insurance plan has different co-pays and deductibles. It’s not easy to know the cost responsible and costs covered by the insurance companies.
  • Resolving billing disputes can involve various steps but it’s always important to document them.
  • Maintain the record of phone calls with date and time of the call and as well as the topic discussed with the payer.
  • This data will be useful if the healthcare billing companies needs to follow up on the submitted claims in future.
  • It will also help to file an appeal with the insurance company or payer.
  1. Eligibility and Benefits:

  • Firstly, understand the insurance plan policy as many policies have limitations. So, it’s always advised to check policy summary plan description or if the plan covers the billed services.
  • If the services are eligible, verify the accurate medical billing codes. Even the smallest errors would lead the claim to denials.
  • Some can result in being charged for the inaccurate services and procedures.
  • Do not automatically assume that you have billed with the insurance. If the healthcare billing companies do not receive the explanation of benefits in couple of weeks from patients appointment, then recheck the submitted claims.
  • Assure that the healthcare billing companies had billed with the accurate health plan and accurate patient demographic details.
  • It’s most important to have a regular follow up with the submitted claim to ensure the payments are processed or not.
  • It might take couple or more weeks for the claim to get approved and process the payments.
  • If there’s a claim denial and the payer refuses to process the payment, find out the reasons for the claim denials.
  • There is an option to appeal or internal review of the reason for the claim denial when it is not justified.
  • Insurance companies will take some time to process the payment after undergoing several procedures.
  • It’s the healthcare billing companies’ responsibility to check and recorrect the denied claims and follow up until a post payment is received.
  1. Claim Denials:

  • If the submitted claims are denied, look into the situation and find the reason for the denials as soon as possible.
  • It’s very important to resubmit the denied claims after corrections within the timely filing limits.
  • If the reason for the denial is not pleasing, then don’t hesitate to file an appeal with the payer.
  • Track the submitted claims and have a regular follow up with the insurance companies.
  • Determine whether the claim was submitted according to the services eligible for the payment recovery.
  • Clearly check the summary plan description for a detailed list of covered services.
  • Meet the deductible before the plan covers portion of the costs and meets out of pockets .
  • Call the insurance company and discuss about the denied claim. Phone calls may resolve the complicated issues and if not, file a formal appeal.
  1. Internal Appeal:

  • If the billing disputes are resolved unsuccessfully, filing an appeal with the insurance companies is must.
  • Every plan has different approach towards appeals, it’s essential to know and learn about the plan before an appeal.
  • Call the insurance payer to find out the appeal process and deadlines for resubmitting the claim.
  • Many appeals fail due to untimely filings and errors in the appeal process. So, be confident and absolute to file the appeal completely before timely filing limits.
  • Never misplace the claims or the demographic details of the patient. Always arrange them as documents and store them securely.
  • Follow up to make sure if the payer had received the appeal and it’s processed.
  • Respond in a timely manner to any queries or request from the insurance company during an appeal process.
  • If the appeal is for an urgent or immediate medical service, update it to the review board as some plans will accelerate appeal process and decide within days.
  1. Independent/External Review:

  • Contact the insurance company if disappointed with the internal appeal process.
  • It’s always better to know or learn about the external review process too, so the healthcare billing companies will know how and when to proceed.
  • Most of the reviews fail due to untimely filings or the when appeal was filed with the wrong department.
  • Include the contact information on every document so that if it’s misplaced, there will be a copy of the records as the originals were not submitted.
  • Send the data electronically to have a proof of submission and get proof of delivery.

Get Frequent Expert Opinions

  • Getting an expert opinion for the performance of your company is crucial if you want to stay ahead of denials and get your finances on track.
  • Regularizing your staff training programs is one such step that will help you improve the overall performance quality of your company.
  • Many leading surveys show that the staff of medical billing companies often complain about extreme time crunches due to lack of proper repeatable processes, thus affecting their performance.
  • Getting an expert opinion can help you plan a proper repeatable process in place which can cut your time consumption by half and improve the work quality.
  • Sometimes experts also talk about handling the evolving legislations and how you can implement them in your organization.
  • It is crucial for you to note what to expect in the upcoming years in the medical billing industry and how you should change your workflow management to adjust to the same.
  • Automation can help you to move ahead of your current performance and scale up your business.
  • Talk to an expert with at least a decade of experience in this field, who can help you to improve your present processes and help you diversify into several specializations.

How Artificial Intelligence makes a difference?

  • In healthcare billing companies, intelligent algorithm continuous to learn and evolve with each claim.
  • However, the healthcare technology advancement concentrates and interests in aggregating data from medical records, claims, authorization across the claim stream.
  • The crucial impact on billing routine may result from interaction with EHR and billing software.
  • Automatically retrieving the information has the power to reduce the labour and perform multiple tasks to make better payments.
  • AI will be able to learn and interpret language and procedures as well as medical codes at ease.
  • It ensures to update accurate medical codes by reducing the transitions that happens with the coding updates.
  • Artificial Intelligence has the ability to get a pre-authorization to submit the claim with all the details to the payer.
  • It also analyzes patient’s medical record and determines the procedure in less time.
  • AI can undoubtedly increase profitability, efficiency andĀ  revenue payments in no time.
  • It would promptly analyze the reason for the denials and rectify the mistakes and ensure the claim is resubmitted.

Hope you got the information on resolving billing issues and AI. If you want us to add more points, please suggest us in the comments. We will consider if relevant. For more queries and updates on healthcare, please subscribe to our blog.

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