Working the Processes

Learn how to control your revenue streamline processes, and clear accounts for services rendered within 7 to 60 days of claim submission, depending on payer reimbursement guidelines.

Over 75% of Providers loose the battle with controlling their revenue, and this is due to not masking the following the principles that drive claim utilization.

Having a working knowledge of the Payers requirements  under specific programs is very important. The program that the payer opts in to reimburse-will follow Clinical Policies, for that particular provider specialty.

Every Claim Counts!

Every Claim Counts “ECC”! In order to understand this rule, one must consider and apply, key actions to ensure proper claim utilization. I have provided several underlining factors, that can impact claim payment.

  • Eligibility
  • Prior Approval
  • Date entry errors
  • Procedure Codes
  • Dx Codes (ICD-10)
  • Medical Necessity
  • Non-Covered Services
  • Insurance / Other COB
  • Insufficient Documentation
  • Medicare Signature Requirement