Benefits of Outsourcing Insurance Claims Processing

by | January 6, 2022 | 7:41 am

Medical billing can be confusing, and includes the need for thorough documentation, verification of patient information, and assessment of insurance details. This is true for startups, small to medium-sized businesses, and larger-sized companies. Outsourcing assistance can help your business streamline operations, creating efficient insurance claim processing, and building better profitability. 

1. Streamline the claim application process

An accurate claim application process requires correct patient information, knowledge of insurance rules, and details of insurance coverage, including coverage for the DME. For example, Medicare covers patient DME only if the supplier is enrolled in Medicare. Medicare also has rules that must be followed to ensure payment for claims submitted by suppliers.

Claim processing includes the need to study insurance details such as co-insurance charges and deductibles. Non-compliance with these regulations or not knowing these details can cause claims to be rejected, delayed, and denied. Outsourcing insurance claim processing can help in many ways.

Outsourcing benefits:

  • Insurance claim filing is more accurate and reliable and less likely to be delayed due to missing information or non-compliance with payer regulations. In the case of large businesses, outsourcing ensures better handling of a consistently high volume of cases.
  • Increased security for patient details through HIPAA-compliance.
  • Access to a team of professionals trained in medical billing, including the rigors of lengthy document reviews, backed by proven infrastructure and expertise.

2. Receive payment on time

Insurance claims must be both accurate and filed on time. Not filing on time can impact payment on the claim.

Outsourcing benefits:

  • Reduced instances of errors. Accurate information provided with the claim application helps ensure efficient processing.  Providing accurate information ensures there will be no delays or rejections.
  • Compliance with application deadlines; understanding of timelines.
  • Insurance claim processing gets done by outsourcing professionals without impacting existing record-keeping or documentation requirements.

3. Improved payer denials

When a claim is denied, it requires a review or assessment. This procedure often takes long hours and is a tedious and time-consuming review process. There is a great deal of communication between the business and the insurance cover provider.

Outsourcing benefits:

  • Ensure better handling of impacted claims without overburdening existing staff and resources.
  • Ensure thorough review and better assessment of the application, including determining what went wrong enough to cause the rejection in the first place.
  • Assisting in-house resources with information without impacting existing business.

4. Stay aligned with the latest in DME/HME billing requirements

Revenue Cycle Management (RCM), the heart of DME billing, is subject to government regulations. Any changes can impact the way payments are made and received. The focus of a business is often on growth, revenue attainment and a strong bottom line. Chasing insurance claims may not be a practical option, especially if efficiencies are missing from the in-house RCM process. Trained resources, such as those providing RCM services, can prove to be expensive for a small to medium-sized business. This can also be costly for larger-sized DME, given the high volume of work needed.

Outsourcing benefits:

  • Outsourced professionals can help shift the burden of work from in-house resources, preventing burnout.
  • Outsourced professionals are well-versed with industry trends and best practices. They can ensure that changes or modifications to regulations are considered.
  • Given their breadth of experience, working with professionals can help DME businesses stay aligned at all times with regulatory requirements.

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