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Mental Health Awareness Month

Medical Claims: How to Review Medical Claims

Reading Time: 2 Minutes

The medical claim review process can be tedious, time consuming, and even stressful due to a system that is often complex and demands accuracy. However, reviewing your claim denials and rejections on a semi-regular basis can save your practice time and money in the long run by reducing the number or denials that you have to deal with in the first place. Here are some of the things you should be doing on a monthly basis to ensure that your medical billing is running as efficiently as possible.

1. Review Your Billing Register

Analyzing your billing register will help you find out how many bills you are have to rebill- and as a result, how many denials there have been. Subtracting the dollars billed out in a given month by your monthly charges will give you the amount of money that has been rebilled over the course of that month, and you’ll start to get an idea for how efficiently your system is running over all.

2. Review Paper Denials and Electronic Explanation of Benefits

The next area to review should be the paper denials and E-EOBs (Electronic Explanation of Benefits) your practice receives. This should give you an idea of why claims are being denied, and help you identify frequent problems such as illegibility of the claim or codes that are frequently reported in error.

3. Identify Recurring Issues

Once you have a good idea of how many claims are being denied and what the reasons are for them, you can start to identify patterns in your denials. Are members of your billing staff writing off some accounts that they shouldn’t be? Are claims being denied due to missing information or missing signatures? Are members of the billing staff selecting incorrect or out of date codes?

Any of these mistakes or many others could be contributing to higher volumes of denials or other billing issues, wasting your practice’s time and money. Identifying these issues early allows you to make adjustments that will make your medical claims billing run more efficiently.

Tired of investing so much time, money, and manpower into your claims filing process? Simplify it by hiring a medical clearinghouse that offers the tools and assistance you need to run your billing department stress-free and with fewer errors. Request a demo today to see how Apex EDI outshines other services and allows you to get back to work helping your patients.



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