Just like other medical practices, your gynecology practice also needs to have efficient processes and policies to ensure the well financial health for your practice. This is exactly where claim submission plays a vital role in your gynecology billing services. However, the truth is that claim denials are inevitable components in your billing system. Recently, kff.org published report where they clearly highlighted that HeathCare.gov insurers denied almost 17% of their total claims, and other insurance companies stated that they denied almost half of the submitted claims. You must need to implement a pro-active strategy to ensure clean claims consistently. First, you need to know what a clean claim is so that you can streamline a perfect denial management strategy in your gynecology billing services.

Know what a clean claim is:

• A clean claim is one that has all the right information, is properly formatted, and sent to the payer on time. It meets the payer's rules and guidelines.

• You must fulfill all the criteria mentioned below to ensure generating clean claims:

• You should always identify all the provided gynecology services, necessary status of affiliation and identifying number if it is available

• Do not forget to identify your patient

• Properly mention the date and place of the provided gynecology services

• Always mention the medical necessity and appropriateness of the service that you are going to provide

• Use accurate service coding to identify the services

• Provide your patient’s insurance company with additional documents if there is any

You only get reimbursed if your claims meet the right requirements and are submitted on time. But keeping up with each payer’s different policies isn’t easy, and their rules are getting more complicated. This can cause delays, claim rejections, and lost revenue. To avoid such scenario and ensure clean claims, you should always implement the strategies mentioned below-

Perfect practices to ensure clean claims in your gynecology billing services:

Make sure that your claims go through either a clearinghouse or charge master system that thoroughly checks if your claims are properly formatted, submitted to the right payer and drafted for the maximized reimbursement. A professional gynecology billing service can enable you to generate accurate claims and receive optimal reimbursements.

Clearly comprehend the requirements:

Make sure you carefully go through the claim submission guidelines and meet all the documentation requirements specified by the insurance company. Always provide a patient’s insurance company with adequate information.

Verify your patient’s insurance eligibility:

One common reason claims get rejected is incorrect or incomplete patient and insurance information. To avoid this, you should verify insurance eligibility before the appointment, during the first visit, and at each follow-up visit to make sure the patient’s insurance is active and will cover the treatment. The best approach is to check eligibility at multiple steps, like when creating the patient record, adding insurance details, and scheduling appointments.

Capture accurate information:

Clean claims include correct dates of service, diagnostic codes, procedure codes, and any other required details. Make sure you collect all this information and double-check that everything is accurate and complete.

Perform error-free coding:

It is always important for you to be extra careful when you are assigning the latest ICD-10, CPT and HCPCS codes. Also, you must know about the NCCI edits that guide you about the codes that you are not supposed to use together. Sometimes, you can use modifiers to show that the services are separate. It's also important to know how to apply medically unlikely edits (MUEs) to avoid claim denials or overpayments. Working with an experienced medical coding company can help you submit claims with the right codes.

Claims scrubbing:

You must use an advanced mechanism to carefully review medical claims before you submitting to the patient’s insurance company for reimbursement. It is a process of identifying errors and correcting them.

Follow a proper enrollment process:

Improper credentialing and enrollment can lead to claim rejections and hurt your revenue. Make sure your providers are properly credentialed and enrolled with payers to avoid missing filing deadlines. Double-check all paperwork, and ensure practice, provider, and payer information is set up correctly in your software and clearinghouse.

Always keep yourself updated:

Stay updated on industry trends, state and federal laws, and payer policies. Sign up for email newsletters and updates from major insurance carriers. Also, check the Centers for Medicare & Medicaid Services (CMS) website at www.cms.gov for any regulatory changes and news.

If you lack enough staff members to handle denial management perfectly, outsourcing your gynecology billing services can be a smart move for you. A professional revenue cycle management company knows what it talks to ensure a perfect denial management strategy where you can see the best claim approval rate with maximized reimbursements.