Patient Demographic is the information provided by the patient to the hospitals or medical centers. Physicians' clinics and hospitals must be extra vigilant in capturing the patient demographics. The vital information works as the core in the medical field, especially for health insurance claims. The patient demographics data comprises patient-specific information like Name, Age, Gender,…

Medicare is Federal Health Insurance program of the United States of America. Medicare began in 1965 under the Social Security Administration (SSA) and now been administered by the Centers for Medicare and Medicaid Services (CMS). Medicare aims to provide health insurance not only for Americans aged 65 and older but also to some younger people…

When insurer processes medical claims, there is an onus on them to determine the financial liability. A thorough process begins that checks every detail of the submitted claim and that sometimes results in claim denials. Now claim denials can sound very abstract unless there is a way to specify precise denial reasons. Medical claims have…

The principal challenge that most medical care providers face while claiming reimbursements is the chance of claim rejection and denial by payers. This not only results in financial loss for the hospitals or medical facilities but has the potential to strain their relations with the patients. Repetition of all the work for re-submission of the…

Health insurance denials have become increasingly common, causing significant revenue loss to practices. Denied claims are the claims that practitioners have submitted claims to the best of their abilities but are refused to be paid for by insurance. Health insurance billing can be complex since patients are covered with different coverage plans. Figuring out what…

Medicaid eligibility verification helps healthcare providers in submitting clean claims, thereby avoiding claim re-submission, reducing demographic-related denials, and increasing upfront collections. Verification done in time not only leads to improved medical billing but also paves the path for overall elevated patient satisfaction. Medicaid eligibility verification process should ideally start before offering the clinical services and…

Eligibility check, the first step in the insurance claim process involves verifying the eligibility of patients on multiple criteria that includes (but are not limited to) coverage, benefit options, prior authorization, and pre-existing clauses. The process being complex can lead to errors and eventually cause rumbles in the bottom line. Let’s look at some of…

“Prevention is better than cure”, a 17th Century proverb that has it’s roots in the medical profession is now finding a stronger calling in the same profession albeit for a different reason. Recent reports shows that “claim denials” are on an upward trend putting your cash flows into jeopardy. Quite different from rejection that happens…