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According to the AMA, inefficient processing of health care claims costs between $21 billion and $210...

According to the AMA, inefficient processing of health care claims costs between $21 billion and $210 billion per year (AMA 2009, 1). These errors cost individual physicians between 10 percent and 14 percent of their practice’s revenue (AMA 2009, 1). Billions of dollars in administrative waste would be eliminated each year if their party payers sent a timely, accurate and specific response to each physician claim” (AMA 2011, 1).

  • Discuss five reasons that claims are paid inaccurately
  • Discuss five ways to prevent the payment from being delayed

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Answer #1

Five reasons that claims are paid inaccurately

  • Neglecting to get pre-certification or authorization
  • Claim rejections due to clerical errors such as incorrect patient name or ID
  • Submission of claims after deadline
  • Insufficient medical necessity
  • Changing insurance companies and change in insurer networks

Five ways to prevent the payments from being delayed

  • Notifying about the payment terms priory
  • Keeping the track of the leverage from the customers
  • Hiring a suitable and proper debt collection agency
  • Using automated systems to remind the clients about payments
  • Asking for part payments from the clients
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