Setting up and managing a billing system for your health care business can be an arduous process. While there are tools that can help alleviate some of the work, you’ll often need to contact a payer directly for claims. Let’s take a look at some of the tenets of home healthcare billing to help you get a grasp on best practices.
A payer is an organization responsible for paying for the services you are providing. These are often insurance companies, but most commonly, home health care providers work with Medicaid and Medicare. When you want to get payments from them, you’ll have to submit a billing claim. When it’s your first time setting this up, you’ll have to submit a detailed document.
You may need to contact the payer, but they are not always forthright about information. You’ll need to apply using the correct claim type and revenue code. If they don’t give away information, the best thing you can do is to send a claim anyway. It will likely not succeed, but you’ll get the information you need so you can complete the follow-up claim.
This first step alone can be time-consuming and tedious. However, it’s something you have to endure for a smoother billing process later, and is required to continue providing services. The key to setting things up is persistence. Here are some things you can do as you’re working on billing:
Before submitting any claims, you have to make sure that you’ve completed registration. Don’t wait to start this process, as it can take several days to complete.
When you’re registered, your payer will have easy access to your information and you’ll have an account to reference when you are inquiring about your claims.
Payers deal with many organizations at a time, so you’ll have to follow up often. They can easily overlook your application and may delay processing your claim.
By calling in, you can get informed faster if there are any issues you need to resolve. Sometimes, you’ll have to make more calls than you want, but this is a better move than waiting.
Some payers have websites where you can inquire about your claims directly. They either have an online database to search for your information or have some means to contact them. While it is not the same for all payers, you’ll have to try first to find out if your claim processes faster there. Some payers also have online resources separate from their website which you can use to expedite the claims process.
Even with your best efforts, you can end up with a denied claim. When you feel that there was a problem, consult with a legal team. Fenton Law Group has helped in these cases. Reach out to us if you have exhausted your efforts in getting your claims paid.