Clean Claim Submissions for Your PT Practice

When you work with patients, filing insurance claims is an integral part of your daily business. When a claim is rejected, you have to resubmit until the carrier is satisfied that the information you have provided is sufficient and correct. This creates more work for your office and delays your payment.

The higher the percentage that get paid at the first submission, the more steady the cash flow to your PT practice. You can improve your claim submission acceptance rate by taking the appropriate steps before, during and after you write the claim.

Gathering Information

A little background work before the patient arrives can help you make clean claims. Verifying three key pieces of information is vital:

1. Check procedure coverage. It is important to make sure that the procedure the patient will be undergoing is covered by the particular plan the patient is on and if the procedure requires prior authorization before the company will pay for it.

2. Check patient’s eligibility for benefits. By knowing details such as the effective dates, services, copay and deductibles for all the patient’s applicable insurance policies ahead of time, you can streamline the process of submitting a claim.

3. Check patient’s information. To file a clean claim, you will need accurate information on the patient, including medical and demographic details. Even if you have filed a claim for the patient before, you may need to update information that has changed.

Following Guidelines

While you are filing claims, make sure you report everything correctly. To do this, you need to be clear on these guidelines:

• Paper vs. electronic submission process
• CPT and ICD compatibility
• Correct modifier to use for the procedure

Creating customized lists for each carrier can help you make sure you are not getting their specific guidelines mixed up. You can reduce your rejection rate by abiding by each carrier’s preferences. 

Editing Claim

One of the most common mistakes that result in submission rejection is the failure to edit claims before they are sent. Don’t get in so much of a rush to send in a claim that you neglect rereading it. It takes much less time to edit your first claim than it does to have to resubmit it because there was a mistake.

Before you submit your claim, you need to check for the following errors:

• Outdated patient contact information
• Incomplete case history
• Incorrect coding
• Unauthorized procedures
• Faulty procedure documentation

It is also a good idea to compile the patient’s medication history. Some carriers require certain medical records before they will process a claim. Having those records ready can expedite its approval.

Your practice may have additional items to add to your to-do list, but this checklist is a good start. As you become more familiar with the carriers you work with, the claims process should go more smoothly. Clean claim submissions increase your first-time approval rate. When you don’t have to resubmit a claim, your PT practice gets reimbursements in a timely manner. Not having to repeat the submission cycle improves overall operations by increasing the efficiency of your work flow. If you need help, we’d be happy to discuss a plan. Contact us at sales@rev-ignition.com