What is the Claim Submission Process in Medical Billing?

Medical billing is an incredibly complex and constantly evolving process within the field of healthcare. This means that it is essential for healthcare organizations of any size to have a billing partner that can stay up-to-date on the latest requirements. This will help organizations remain organized and efficient, avoiding any penalties or losing important relationships with payers. 

In this article, we’ll be discussing the three key reasons why accurate medical billing claim submission is essential for all types of healthcare organizations as well as the typical steps in the claims submission process itself. 

Why Accurate Medical Billing Matters

Proper Reimbursement

Inaccurate medical billing claims can lead to delays in reimbursement, which can put a strain on your practice’s cash flow. Furthermore, some incorrect claims may even be denied outright, resulting in even greater financial losses for your healthcare practice. It’s best to make sure that all of your billing is completely accurate from the start so that you can have quick and easy reimbursements without any delays or further issues. 

Maintaining Relationships With Payers

Payers are constantly changing their reimbursement policies, and it is important for healthcare organizations to stay on top of that so they can maintain good relations with them. If claims are consistently being submitted incorrectly, your organization’s payers may become disgruntled and less likely to work with the organization in the future. This can all be avoided by making sure that your practice’s billing management is consistently accurate and efficient. 

Avoiding Penalties

Inaccurate medical billing can result in harsh monetary penalties from both payers and government agencies. These penalties can add up quickly and put a heavy strain on the finances in your organization. Accurate medical billing claim submissions are the best way to avoid incurring these penalties and making sure that your organization’s finances are not strained. 

For all of these reasons and more, it is crucial for all types of healthcare organizations to maintain consistently accurate medical billing claim submissions. By working with a reputable billing partner, organizations can ensure that their claims are submitted correctly and in a timely manner, allowing them to avoid penalties, maintain positive relationships with payers and complete the proper reimbursements.  

Claim Submission Process

In order to receive reimbursement from payers, there are numerous steps that medical billing providers must follow in a specific process for claim submission. Even though his process can vary depending on the type of insurance, there are still some general steps that all claims submissions follow. 

The first step in the majority of claim submissions is to verify patient eligibility. This includes checking to see if the patient has coverage and if they have any preconditions that would impact their coverage. Skipping over or not completing this step can lead to issues with the insurance company down the road, so it is crucial to completely verify the patient’s eligibility and if they have any preconditions. 

Next, the medical biller will gather all of the documentation that they need to submit the claim. This includes documents like diagnosis codes, procedure codes, and any other relevant information that will be needed for the specific claim. 

Once all of the necessary documentation is gathered, the biller will submit the claim to the insurance company. Upon receiving the claim, the company will then review the claim and determine whether or not they will cover the cost. 

If the insurance company denies the submitted claim, the biller can then choose to appeal the decision. Once approved, the biller will collect payment from the insurance company and send it to the medical provider to finalize the process. 

By following these steps, medical billing providers can ensure that they are submitting accurate and complete claims that have a good chance of being approved for reimbursement. This helps to get money into the hands of medical providers more quickly and efficiently, making it a pain-free process for everyone involved. 

Bill Better with the Right Digital Solution

Harris Integrative is a leading innovative developer of the most sophisticated finance tools in the medical industry for rural healthcare organizations. Our digital billing solutions streamline the billing and claims process to make it easier and more efficient for your own organization and your administrative staff. 

To learn more about how our digital finance solutions can improve your healthcare organization, schedule your 15-minute call today.