How to Get Reimbursements From Insurance (as a Private Practice)

As a healthcare provider, you rarely get paid for your services up front. Generally speaking, you provide patients with the healthcare services they require, perhaps receiving a small co-pay at the time of the office visit, after which you bill the patient’s insurance provider and go through the long and sometime arduous process of attempting to get reimbursed for services rendered.

This process can be lengthy even when done correctly and result in delay of payment or denial of claims if done incorrectly. This can have a major impact on the cash flow for your practice, impacting payroll and your ability to keep operations up and running. In other words, it’s important to streamline the process. Here’s the best way to get reimbursement from your patients’ insurance providers.

Collect Insurance Data

Any time your practice receives a new patient or a current patient changes insurance, it’s important to collect all pertinent data for the purposes of billing. New providers and/or policies could entail different billing practices.

For starters, you need to confirm payment responsibility. Most policies entail some sort of co-pay for office visits that the patient is responsible for. More importantly, however, certain providers or policies will cover different services in different ways.

To an extent, doctors can work the system, ensuring that services are rendered, coded, and billed to procure maximum payment from insurance providers, alleviating the financial burden on patients (who are, after all, paying for their insurance policies already). However, certain treatments may require partial or complete payment from patients, and you need to be prepared to inform them before any services are rendered.

Accurate Diagnosis and Treatment Information

Whether you perform medical billing and coding in-house or you send out records to a service to bill and code for you, it’s extremely important that the information you provide is accurate if you want to be fully reimbursed. This includes patient information (name, address, policy number, etc. should all be error-free on submissions), as well as appropriate diagnosis and treatment information.

Insurance providers are looking for the slightest error that allows them to deny claims, so you must be familiar with what each provider and policy covers and make sure that terminology for diagnosis and treatment precisely match billing and coding if you want the best chance for claims to be approved and paid.

Follow Up and Reporting

If claims are held up, only partially paid, or denied completely, you need to know what’s going on and why. This requires follow up, which you can do on your own or ask your medical billing and coding service provider to do for you.

Most services will automatically follow up if claims processing exceeds a certain time limit. However, you should also choose a medical billing and coding service that provides regular reports detailing how your claims are being handled to help you gauge when you might get paid and ensure that your service is doing all they can to get you paid in a timely manner.

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