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 Guidelines to Improve Reimbursement

The organizational flow of information and accurate documentation and coding is crucial to processing third party claims.
To prevent claims from being rejected, the business process needs to review such areas as:

• inaccurate or lack of coding

• incomplete claims

• lack of supporting documentation

• poor communication with the payer

• not billing for services rendered

The overall reimbursement process is a series of sequential or interconnected but independent steps, starting with the patient’s visit to the facility. The steps involve:

• Assuring that all patients are registered for scheduled or walk-in appointments.

• Obtaining accurate and detailed insurance and demographic information during the registration process.

• Accurately documenting the service, examination, and patient care by all providers (physician, mid-level practitioner, nurse, or others).

• Capturing and coding correctly all reportable and billable services.

• Billing all billable services that are not only reimbursable by the insurance company but also supported by documentation.

• Reconciling claim payments to assure correct payment

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