As a business owner, it never feels good when you lose money. However, a countless number of medical providers lose money every year due to denied payments from insurance companies. Submitting payments to an insurance company is a bit of a challenging matrix, and even one small error could lead to a denial.

Individual Information

A large insurance company can easily have hundreds of thousands, if not millions, of subscribers. To keep track of each subscriber, all insurance companies require that all the individual information sent in is 100% accurate. In fact, they are very tedious and particular about the process. 

For instance, if you submit billing for a patient whose address is 123 Sunshine Way, but you submit the information as 123 Sunshine Court, the insurance could deny payment because the individual information is unverifiable. A careful review of all the patient's information is important to prevent this type of problem.

Industry Changes

Insurance companies make changes to their submission processes regularly, and it's up to the medical provider billing team to stay current with these changes. One of the more critical changes is contract terms for reimbursement. 

For example, an insurance company can change the term from 180 days to 90 days at will, as long as they provide the change in writing. If a provider's office forgets this information and submits reimbursement following the old 180-day schedule, the payments will be denied. It's imperative to stay current with all changes.

Prior Authorization

Depending on the type of insurance the patient has, the insurance company might require prior authorization before completing any type of testing, treatment, or procedures. When a provider performs the treatment and then submits a reimbursement claim — they're likely to be met with a denial. 

While the patient will receive the care they need, they will do so at the expense of the provider's office. Similar to reimbursement terms, authorization requirements are spelled out in the insurance contract and must be strictly adhered to.

Third-Party Billing Services

In a busy practice with limited staff, there is not always extra time in the day to ensure all of these details are covered. However, a third-party billing professional can cover all of these steps and more to not only reduce the risk of an insurance company denial but also help you increase your returns on your private payer invoices. Partnering with a billing provider can help you increase your revenue.

If you need assistance at your practice, contact a third-party patient billing service like Medical Financial Specialists for additional information.