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eClaim Solution > RCM  > Medical Insurance Claim Denials & How To Eradicate Them!

Medical Insurance Claim Denials & How To Eradicate Them!

America’s healthcare industry is complicated in comparison to other regions due to its high dependence on insurance services. All the medical aid, treatment, and procedures provided to patients are mostly on insurance panels and their claiming procedure is usually carried out by the respective hospital where the patient opts for treatment.

However, it is easier said than done. Insurance claim procedures are a convoluted process where a minor mistake or omission of useful information of data and patient information can result in a denial of patient billing reimbursements.

What Causes Hindrances In Insurance Claiming Process

Medical insurance claim denials can cause significant problems for hospitals. When a hospital provides medical services to a patient who has medical insurance, they submit a claim to the insurance company for payment. If the insurance company denies the claim, the hospital may have to absorb the cost of the services provided, which can have a significant impact on their finances. Some of the problems that medical insurance claim denials can cause for hospitals include:

  1. Reduced Revenue
  2. Increased Administrative Cost
  3. Delayed Cash Flow
  4. Reduced Patient Satisfaction
  5. Legal Issues

Reduced Revenue:

When insurance companies deny claims, hospitals may not receive payment for the services provided, which can lead to a reduction in revenue. This can be particularly problematic for hospitals that are already struggling financially.

Increased Administrative Costs:

Hospitals may need to allocate additional resources to appeal denied claims or to work with insurance companies to resolve issues with claims. This can increase administrative costs and take time away from other important tasks.

Delayed Cash Flow:

When claims are denied, hospitals may have to wait longer to receive payment for the services provided. This can cause cash flow problems and make it difficult for hospitals to pay their bills on time.

Reduced Patient Satisfaction:

Patients may become frustrated if their insurance claims are denied, which can lead to a reduction in patient satisfaction. This can have a negative impact on the hospital’s reputation and lead to a decrease in patient volume.

Legal Issues:

If insurance claim denials are not handled properly, hospitals may face legal issues. For example, if a hospital fails to appeal a denied claim within the required time frame, they may lose the right to appeal the decision.

Overall, medical insurance claim denials can have a significant impact on hospitals, affecting their finances, operations, and reputation. Hospitals must work closely with insurance companies to minimize claim denials and ensure that they are reimbursed for the services they provide.

The Benefit of Onboarding a Medical Billing & Coding Services Provider!

When your hospital signs up for a medical billing & coding service, the hassles of filing insurance claims on behalf of patients is streamlined immensely. Here are some benefits of outsourcing your medical billing and coding to a professional service provider

Data Enrollment of Patient

The first and the most crucial step to ensure that there are no errors in the insurance claiming procedure is the step where data of the patient is collected and entered. Here, all the relevant information, such as the patient’s demographic and basic information, type of medical services being claimed, coding against the insurance type and eligibility is entered in a form. A proper service provider would provide seamless and error-free pre-registration and registration of the patient to ensure everything is done smoothly and timely.

Coding & Assignment of Claim Type

Coding of the insurance claim is the most crucial process out of them all. Here, you will assign code against the medical services and procedures provided to the patient which allows the medical insurance agency to reimburse against this code. A service provider would have all these medical codes listed down, allowing the insurance claim procedure to reimburse timely.

Cost Effectiveness

To manage and execute insurance claims, it can garner up huge costs for the medical institute to bear. By outsourcing these services to designated professionals, your hospital can save up immensely on costs.

Revenue Cycle Management

With your revenue cycle management in the hands of a professional medical billing and coding service provider, your insurance claim payment cycles will be curated and managed by the service provider, allowing your hospital to reduce operational costs by a mile and lessen the burden of resource allocation and human resources.

eClaim – Streamline Your Medical Insurance Claims With US

eClaim is a professional Urgent Care Medical Billing serivce provider in the medical industry of the USA. We recognize the hurdles and obstacles faced by the hospitals across the country and we offer professional solutions just so your hospital can reap the revenue from insurance claims and not worry about the operational costs.

Let us get you started! Contact us today.

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