What health insurers do to your claim
The American Medical Association (AMA) developed the resource "Follow that claim" to provide physicians and their practice staff with an understanding of what happens to a claim once it leaves the practice. A claim is followed as it moves along the claims submission and health processing networks. Understanding this flow will enable physicians to better address the delay, denial and reduced-payment tactics used by third party payers.
"Prepare that claim" and "Appeal that claim" were developed to help physicians and their practice staff review the efficiency of their current internal claims management process as well as understand the payer’s role in the claims process. These resources contain sample forms and policies which can be adapted to fit the specific needs of a physician practice.
Additional resources include:
- "Is your practice losing revenue through inappropriate health insurer adjustments?" emphasizes the need to carefully review health insurer explanations of benefits, in order to pinpoint and address underpayments based on inappropriate adjustments by the health insurer.
- "The effect a payer’s claim edits can have on the repricing and payment of your claim" details the ways in which claim edits applied by a payer could affect your practice’s bottom line. This resource also highlights how a negotiated fee with a payer for a specific service performed does not necessarily translate into payment of that fee on a claim.
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Learn how to select a practice management system that will reduce your time spent on manual administrative tasks that occur throughout the claims revenue cycle and replace them with automated solutions.