What Clean Claim Rate Should a Dermatology Billing Partner Actually Guarantee You?

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Choosing a dermatology billing partner based only on a promised clean claim rate can be misleading. A billing company may tell you that it maintains a 95%, 97%, or even 99% clean claim rate. But before accepting that number, you need to know how the rate is measured, what claims are included, and whether those clean claims are actually being paid correctly . For dermatology practices, this matters because a claim can pass an initial billing check and still face problems related to medical necessity, modifiers, procedure coding, payer policies, or underpayment. A clean claim rate should therefore be viewed as one part of the revenue cycle, not the entire performance picture. What Clean Claim Rate Should a Dermatology Billing Partner Guarantee? A reasonable contract target is 97% or higher , provided the billing partner clearly defines the metric and measures it consistently at the payer level. The percentage itself, however, is only part of the agreement. A dermatology practice should a...
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3 Unknown Myths about AR Pile-Up

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Account Receivable (AR) is one step that divides the reimbursement and claims; the older the claim gets the harder it becomes for claims to get reimbursed. For practice when AR slips below a certain level you either have a pretty large backlog to be sorted out, or you can see that it becomes impossible to tackle the day’s run-out without any futile results.   The major challenge is that in recent years the financial responsibility and medical care for patients have compounded but on the other hand, we see that the widespread reach of more and more products through new healthcare insurance exchanges has prompted higher deductibles or coinsurance for physicians. As physicians cope with unfamiliar issues with different insurance companies, the AR suffers dearly. Here are three factors you can look into to solve your AR pile-up mess.

3 Unknown Myths about AR Pile-Up

  1. Step up the insurance verification process

The starting point of addressing AR issues is the first step of Revenue Cycle Management (RCM)- verifying patient data. “Verifying the insurance coverage and eligibility well in advance even before an appointment is booked is one step taking towards reimbursement,” said Sonia Bains an AR manager with MBC in Florida. According to the recent data, we have received from our new clients 70 percent of denials happened because the practice failed initially to verify the insurance eligibility and patient coverage.

A third-party website-payer or software built into the practice management can prove to be a saver for the practice answering questions like how much of the deductible has been used by the patient? Whether the policy has been suspended due to non-payment of premiums?

Checking this information can certainly save up loads of denials and appeals for your practice.

  1. Accurate Coding

For physicians, it’s important to form the channel of documentation and coding. If physicians want to improve their coding as they deal with multiple settings during their practice tenure coding and documentation become one factor that will directly impact the charge capture.

“The challenge becomes complex as physicians increase their area of expertise. The documentation becomes an important task even in various cases when evidence of fraudulent billing. The need for documented billing has helped improve the accounts receivable by many folds. ” said Insurance manager Reeves Joy.

To learn more about the 3 Unknown Myths about AR Pile-Up, click here: https://bit.ly/3ZDowKC, Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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