5 Reasons for Medical Reimbursement Delays and How to Avoid Them


5 Reasons for Medical Reimbursement Delays and How to Avoid Them

No one wants to end up in a hospital due to some unexpected illness or accidents. For one thing, medical bills can add stress to the patient and the family members as well. This is one sad truth about health care: it can be expensive and even drain up your savings if you are not financially prepared for it.

One way to prepare from unexpected situations such as this is by getting medical insurance. This can help a lot in alleviating medical expenses and have the best treatment and care you can get. Insurance companies often team up with the hospital and medical establishments so that patients can take advantage of the health care they deserve.

While a lot of people can benefit a lot from using health insurance, medical institutions tackle their own problems, too. Most of the time, they were not able to maximize their medical practice reimbursement and can be time-consuming most of the time.

Reasons for delays in reimbursement and claims

There are some reasons why delays in medical practice reimbursement happen and what medical providers should do to avoid such delays.

1. Error in patient information

This is one of the most important parts needed to claim reimbursements. Make sure all of the information needed is correct. Also, make sure to secure a copy of both the front and back of the patient’s insurance cards and ensure that the patient’s information is updated. Also remember that health care providers should submit the claims within a year the medical service has been provided.

2. The medical procedure is not covered by the insurance

Make sure that the medical procedure is covered by the insurance to avoid claim/reimbursement denials. It is also important to seek authorization first, especially before doing any major procedures such as surgeries. Otherwise, reimbursements may be denied.

3. The patient is ineligible for the insurance coverage

There are times wherein dependents (ex. children), aside from the policyholder, is carried by the insurance policy. However, make sure to check first with the insurance provider if the child is eligible for insurance coverage. This is because there are some insurance plans that only cover children at a certain age.

Other tips to avoid reimbursement denials

Annual Health Check Up Lifestyle

Insurance claim denials can take a toll, especially to health care providers. While policyholders get to enjoy the benefits of health insurance, this is not always the case for a lot of health care institutions.

Medical practice reimbursements often happen mostly due to misinterpretation of the insurance coverage. To avoid reimbursement denials, here are some other tips to remember.

  • Make sure to obtain updated patients’ information on every visit. Take note of every detail, including the middle initial of the patient and the address number.
  • Seek authorization first from the insurance provider before doing any medical procedures, whether minor or major.
  • Check with the insurance provider all of the covered illnesses and medications to avoid reimbursement delays.
  • Avoid delaying the filing of insurance claims and make sure to do it on time.

These are only some of the most important reminders medical care providers have to do to avoid reimbursement delays. Health care is a noble industry, and its workers and institutions deserve to be compensated well and properly.

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