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Medical Claims Processing: How to Pick the Best Medical Claims Processing Software

By the year 2024, nearly $1 out of every $5 will be spent on healthcare in the United States. If you’re a healthcare professional or part of a medical association, you’ve likely struggled with the most effective way to handle your billing. You’ve also wondered how to grow your business.  The right medical claims processing software can help to streamline every aspect of your business. How do you know if you’re selecting the right option?  Here, we’re sharing with you the top 5 things your medical claims processing software should be able to do for you. 1. Meet The Needs

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Medical Claims Processing: 5 Tricks to Easily Streamline Medical Claims Billing

Is the medical claims billing process a painful one for your practice? It doesn’t have to be. Taking a few simple steps to simplify medical claims billing can drastically improve your collections and even increase your practice revenue. If you’re ready to make this process easier, check out the following 5 tricks below! 5 Tips to Streamline Medical Claims Billing 1. Take Inventory First, take an inventory of where you are. This way, you can establish goals for, and periodically analyze, the progress and status of your accounts. You’ll want to do a periodically analyze the progress and status of

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Medical Billing Software: How Do I Spot Medical Billing Errors?

Medical claims can be difficult to understand. When a patient has a serious health condition, there may be several provider, specialists, and medical facilities involved in their care. Bills can be loaded with abbreviations and medical terms that the average patient may not be familiar with. It’s important to arm yourself with the confidence to question a potential billing error.   The first step in questioning a medical claim received for services is to make sure you review each detailed charge. If you receive a summarized statement, you may need to request an itemized bill. Read through the dates of

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Medical Billing Clearinghouse: What You Should Know Before Challenging a Medical Bill

Many patients have higher deductibles with their medical plans today than they did in the past.  This means they have an interest in paying closer attention to the medical claims they receive.  While many healthcare providers provide payment options intended to help the patient, before challenging a medical bill there are some key issues to keep in mind. First you will want to ensure that you clearly understand all the charges. This means you may need to ask for a detailed bill, showing every service performed by your provider. The line item bill should also clearly indicate others the provider

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Medical Billing Clearinghouse: Electronic Health Record Use Adopted by an Increasing Number of Practices

Physicians and healthcare providers are continuing to invest in the use of medical claims software systems. According to a survey conducted by the consulting firm Software Advice, they are doing so to increase efficiency for medical staff and for their patients. The survey found that 35 percent medical claims software users indicated that they are investing greater amounts in their systems than in previous years. One major reason is the desire for mobile access to patient information. Medical billing software partners are able to keep up with technology and provide patient portals for prescribing medication, managing lab results, and communication. While

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Medical Billing Clearinghouse: What Can I Gain by Using Billing Software? What Can I Lose If I Don’t Use It?

  Most healthcare providers spend years learning how to build a successful medical practice and focus on providing top notch patient care. Yet, sometimes ignored, medical claims, is an extremely important component of your business. Billing challenges can slowly drain your financial outcomes and become a serious distraction for office staff. The business side of your healthcare practice can be improved substantially with the implementation of a medical claims software. Working with a billing partner allows you to remain focused on patient care, while they handle the burden of worrying about insurance companies rules and constantly changing coding standards. It’s

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Claims Processing: Could My Claims Be Returned by the Insurance Company? Why?

Claims can be returned for a variety of reasons. The most common cause for a rejected claim is missing or inaccurate information. For example, errors in patient data such as the date of birth, age, sex, address, or name will cause an immediate return. Then there is provider information and insurance identification numbers, which can be easily and unintentionally misrepresented. When the insurance company payer receives a claim, they check to make certain the patient is covered by the policy and all treatment codes match the appropriate diagnosis. Sometimes preauthorization records, referring physician identification numbers, or evidence of medical necessity

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Claims Processing: What is Claims Adjudication?

This is a short summary of the claims adjudication process. For a comprehensive whitepaper outlining the entire process please complete the whitepaper download form below. After a medical claim is submitted, the insurance company determines their financial responsibility for the payment to the provider. This process is referred to as claims adjudication. The insurance company can decide to pay the claim in full, deny the claim, or to reduce the amount paid to the provider. When an insurance company decides to reduce a payment to the provider, they have determined that the billed service level isn’t appropriate for the diagnosis or

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Medical Claims: What Does the Medical Claims Process Look Like?

The medical claims process begins when the patient goes to the healthcare provider for any service, from refilling a prescription to major surgery. The patient is responsible for paying the insurance deductible after the visit and providing insurance information to the healthcare provider. Typically, front office staff begin the claims process with a pre-registration form. Information such as patient name, birth date, and insurance policy number is gathered. Keeping current medical records helps expedite the billing and patient check in process. It can also eliminate errors that may occur. For example, if the patient forgets to bring insurance information with

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Medical Claims: Will Medical Claims Software Help My Practice? What Should I Look For?

Implementing a medical claims software is an easy way to see an immediate increase in revenue for your health care practice with a minimal investment. The software allows your staff to focus their time on what’s really important, the care of patients, rather than tracking and submitting medical claims. There are a number of features to look for in a good medical claims software. First, you will want to make sure the software partner you select offers the best customer support possible. Look for a company that can offer the assistance of a well-trained, knowledgeable support staff to address any

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Insurance Claims: Tips for Negotiating Claims with Insurance Companies

When healthcare providers and staff understand how to communicate with insurance companies, it can make billing and medical claims processing much easier. It’s not uncommon for an insurance adjuster to offer an initial settlement at a lower amount than you requested. Negotiating a final settlement can have a positive impact on your business. It’s imperative to first determine what you believe your medical claim is worth and decide on a minimum settlement figure that you will accept. When you receive an offer that seems low, ask the insurance company to give you specific reasons why the offer is so low. Then

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Oral Surgery Claims: Things You Should Know About Submitting Oral Surgery Claims

There are several costly mistakes oral surgeons can make when it comes to submitting oral surgery claims. The billing and coding challenges are unlike any other medical specialty. Apex EDI has the expertise and experience to make processing dental and oral surgery claims easier for you and your staff. First and foremost, it’s important to know how to capitalize on both the patient’s medical and dental insurance to receive the maximum reimbursement. This requires educating your staff on how to properly request insurance cards, check for benefits and authorize treatment. Your patient’s benefit from lower out of pocket expenses when

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Chiropractic Claims: Chiropractic Care vs. Physical Therapy

When a patient experiences a bodily injury or physical trauma that requires treatment, they may see a chiropractor and a physical therapist. Apex EDI is familiar with both types of claims. Chiropractors routinely diagnose and treat mechanical disorders of the musculoskeletal system. Physical therapists help restore physical mobility and functioning. Common chiropractic claims include the diagnosis of medical conditions related to joint pain. Patients often receive a chiropractic adjustment, electrical stimulation, acupuncture or pain management therapy. Sometime a chiropractor will make a referral to a specialty provider to treat ongoing traumatic conditions.   There are at least twenty different types

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Medical Billing Clearinghouse: What Is a Clearinghouse Service?

can become increasingly complicated as a healthcare practice grows. A clearinghouse service, like Apex EDI, helps eliminate billing errors and ensure claims are paid on time by working as an intermediary between the provider and insurance company. We check to make sure no errors are made before submitting claims for payment. All procedural and diagnosis codes are checked for validity before being submitted to the insurance company. We also ensure that each procedure code is appropriate for the diagnosis code that accompanies it.   Another benefit of working with a clearinghouse is that you don’t have to worry about technical

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Medical Claims Processing: Tips for Appealing a Denied Medical Claim

Medical claims may be denied for a variety of reasons. Fortunately, there are some ways for patients to appeal a denied claim within six months of the healthcare service. Follow these tips and you will have better success recovering denied benefits from your insurance company.   First, it’s important to understand exactly why the claim was denied. When an insurance company denies a claim they use codes to explain how they arrived at their decision. Look for the explanation of these codes in the explanation of benefits document (EOB) provided by the insurance company. If you need more information, call

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