Medical Billing Cheat Sheet

What does it take to file a clean claim? Some nights we stay awake thinking about those flawless submissions. Why? It’s because there’s an ever-moving number of claims denials. Coming to Gables Medical Billing to get a handle on your revenue cycle management is always a great first step in filing a clean claim.

1. To begin, you’ll have to ensure the provider is licensed to practice on the patient’s date of service.
2. Then you have to verify that every procedure has a supporting diagnosis code, eliminating any questions about medical necessity and that there are no missing or expired codes.
3. After all of that, you have to check that the patient was covered at the time of service and that the particular procedure is also covered.
4. The claim must include all of the required information, like the name, address, date of birth, identification number, and group number, all in their correct fields.
5. The payer must be properly identified and the claim is going to the correct payer.
6. Then you have to make sure that you are filing the claim in a timely manner, in accordance with the payer’s agreement with the provider.

That’s how it’s done. You submit to the correct insurer and check in often so that you know the claim status if there’s a need for resubmission and when you will receive your reimbursement. If you find yourself struggling to get any of these steps done, or that your revenue cycle management is less than stellar, our team at Gables Medical Billing would love to help you receive timely and appropriate reimbursement for all of your hard work.