Tips for Improving Medical Claim Reimbursement

For medical practices to get their claims paid, they must understand how various claims management components affect reimbursements. To succeed with reimbursement, consider how the multiple patient-provider relationship components fit in the revenue pattern and may introduce gaps, resulting in risk or loss.

While medical billing and coding may be challenging, you can minimize claim denials and work on each claim denial until it’s resolved, improving reimbursements. Below are nine tips for improving medical claim reimbursement.

Invest in automation

Maintaining various insurance policies and diagnostic codes can be overwhelming. However, software providers can update requirements and codes automatically. This reduces research time, letting your billing team take more time to double-check claims to ensure they meet all the requirements. The automation software also streamlines processes and flags things that need resolving before submitting the claims. It also eliminates duplication chances, reducing errors and saving time.

The software also lets you automate repetitive billing tasks, including filing individual claims, producing and issuing payment reminders, and helping in picking the correct medical billing codes. You can seek Medicaid reimbursement help or any other software provider to automate your billing processes, track the services you render and monitor progress.

Develop a clear collection process

To ensure your facility’s financial health, you require a collection process. Establish a step-by-step strategy that clarifies the steps for all involved to significantly boost revenue cycles by ensuring the patients are well informed of their responsibilities. An ideal collections process should have clear terms informing patients about what you expect of them regarding debt repayment. When developing a collections process, gather patient information, including their phone number, address, workplace, email, and more. Make photo IDs a requirement at the patients’ first visit, mainly if the bill might be sent to a collection agency in the future.

You can verify patient addresses by checking with them frequently to ensure their contact information and addresses are still the same. When drafting new patient paperwork, add an agreement that lets you leave voicemail messages concerning billing matters. Verify their insurance eligibility each time your patients visit to prevent claim denials. Consider collecting balances due and co-pays upfront to avoid the labor and paperwork for chasing them later on. Establish multiple payment options for your patients.

Maintain patient files and keep them up-to-date

When you don’t have your patients’ exact details, handling medical billing claims accurately may be challenging. Each time your patients visit, you should have your staff verify their demographics and insurance information. This is because the patients might have different insurance providers or have changed jobs. The insurance nature might have changed too.

For instance, the patient could have upgraded to a costlier plan with lesser deductibles or a cheaper plan that needs more out-of-pocket expenses. As you update your patients’ details, explain the process so that sudden higher bills don’t surprise them. Always double-check details like subscriber information and policy numbers. This information must match up with the third-party payers’ details.

Manage your claims properly

Most medical bills have errors, and since insurance companies are strict regarding accurate coding and medical billing practices, they’re likely to be rejected. The submission, rejection, correction, and resubmission cycle may take time, usually resulting in you waiting for months before getting paid for services rendered. Considering the effort and time that goes into editing and resubmitting erroneous claims, it’s essential to get them right the first time. You can do so carefully and correctly, inputting all the details and then double-checking to ensure your claims are error-free before submitting them.

The common error sources you can consider are incorrect patient, provider, and insurance information, duplicate billing, poor documentation, lack of explanation of benefits on denied claims, unclear/ missing denial codes, or denied claims number references. Upon submitting your claim, you can follow up with the insurance company’s representative to be updated on any issues they might have encountered.

Stay updated on Medicare standards

Even when you’ve invested in software that flags inaccuracies, your billing team and the rest of your practice should familiarize themselves with Medicare billing regulations and other payers. To remain up-to-date, your billing staff should attend conferences and subscribe to newsletters to avoid getting claims denials because of ignorance. Sharing what they learn with other practice members helps everyone stay updated.

Consider outsourcing

While implementing proactive medical billing practices might help, the tasks can still be overwhelming. With so much to do, medical practices may not have enough time to stay current regarding coding standards, billing regulations, and insurance companies. This may cause crucial details to slip, leading to denials, underpayments, and rejections that might cost you money and time.

However, you can outsource your coding, and billing needs to experienced third-party experts. This ensures that your submissions are made on time and that your practice remains compliant with new health care regulations. This also gives you more time to focus on your patients.

Handle rejected or denied claims promptly

Rejected claims are those yet to be processed because of error discoveries. This prevents the insurance company from paying the claim as is. Denied claims are those the insurance company already processed but deemed unpayable because of errors detected after processing or discovery of payer-patient contract violations. While a rejected claim may be rectified and then resubmitted, a denied claim should be appealed and then resubmitted. While double-checking eliminates the risks of your claim getting denied or rejected, you should handle them promptly if they occur.

Reduce coding errors

In a claim, coders use standardized codes to describe performed procedures, making it easier to process and decipher claims. While this may offer a standard way of describing procedures, coding errors such as mismatched, missing, or incorrect codes may still happen. Nevertheless, clearinghouses might not catch other mistakes such as non-specific diagnosis codes, incorrect modifiers, and upcoding. Double-checking codes before submitting your claim always helps. You can also use medical coding resources to cross-check to ensure the right code usage.

Avoid missing deadlines

Medical billing can be complicated, meaning claim denials are unavoidable. However, your denial shouldn’t be because you didn’t file your claim on time. Missing deadlines means losing that money forever. Ensure your claims are always on time to avoid untimely claim filing denials.


Maximizing your practice’s reimbursement means maximum revenue. Consider applying these tips to improve your medical claim reimbursements while preventing denials.