Dialysis providers face financial and operational challenges due to flat or reduced reimbursements, staffing shortages, and increasingly complex insurance requirements. Dialysis centers, nephrologists, and renal pharmacies also have to wrestle with the impact of a growing shift in dialysis care to the home setting. The good news is that despite these challenges, dialysis providers can sustain strong cash flow, reduce costs, and mitigate denials by outsourcing their revenue cycle operations to the medical billing company, Medisys Data Solutions. In this article, we discussed how we can help in improving insurance and patient collections for dialysis center in today’s difficult operating environment.
Identify Insurance Coverage
Failure to identify existing insurance coverage can result in significant write-offs. Most of the time providers confuse between active insurance and covered services. Patients who have active insurance coverage don’t mean their insurance will provide payment for planned services. We provide eligibility and benefits verification services for every patient visit. We share insurance coverage reports which will help to understand covered services, the need for prior authorizations, unpaid deductibles, and co-payments. Patients sometimes present themselves as self-pay even though coverage exists, such incidents can be avoided due to insurance coverage reports. We can help identify undisclosed coverage for end-stage renal disease (ESRD) patients through Medicare/Medicaid, Disability/SSI, third-party liability, commercial insurance, state and county programs, social programs, and charity.
Managing Prior Authorizations
Streamlining the prior authorization process is essential to help ensure optimal reimbursement for renal care rendered, particularly with commercial insurance and Medicare. The prior authorization process is time-consuming and needs to be handled by a billing expert. Failure to take prior authorization may lead to permanent denied payment from insurance carriers. Our team will analyze every insurance coverage report and highlight the need for prior authorizations. We will complete the registration, fulfilling medical necessity requirements. We will also capture prior authorizations reference number which will be required while submitting the claim.
Reading Electronics Remittance
To ensure accurate insurance reimbursements, just submitting a clean claim is not sufficient, you have to track every single claim. The insurance carrier will share electronic remittance advice (ERA) or explanation of benefits (EOB) sharing payment status for every single claim. We will read every ERA to find out rejected and denied claims, we will also highlight claims with reduced payments. Based upon remark codes we will work on rejected and denied claims and will also look for payers’ requests for additional documentation. We will post payments in your billing systems as per every line item in ERA. With the payment posting report, you will get a complete idea about the number of paid claims, rejected claims, denied claims, and insurance reimbursements received.
Billing for Recurring Services
Creating claims for ongoing ESRD care requires repeatedly documenting the same details on each claim. Our prior submitted claims act as a reference for dialysis staff where they can simply replicate the unchanged data from prior visits and can update date-of-service and other information to expedite claims processing.
Improve Medicare Reimbursements
Medicare is one of the largest payers of dialysis services, so ensuring a problem-free and expedited Medicare claims submission process is essential to strong cash flow. We check your Medicare claims for eligibility errors and submit the claim without any delays. It can help expedite reimbursement, reduce AR days, and speed your Medicare primary claim cash flow. Claims needing attention are highlighted and sent to providers for additional details.
Collecting Patient Liability
Our insurance coverage report will help to identify patients’ insurance coverage and patient liability/responsibility. You can also share this insurance coverage report with patients to give them cost estimation for the services. You can collect deductibles and co-payments at the time of visit from such well-informed patients. You can also provide them with various payment options including online and credit card payments for better collection of the patient liability. We can help you to collect more patient payments, get paid faster, reduce your collection costs, and ultimately help to lower patient write-offs.
A reliable medical billing company
Our deep knowledge of renal care billing and understanding of payer policies and reimbursements guidelines can help dialysis centers collect reimbursements accurately and more quickly. Unlike other billing companies, addressing a specific revenue cycle issue, Medisys Data Solutions provided complete revenue cycle solutions for your dialysis center. If you’d like to learn more about our dialysis revenue cycle management solutions, contact us at info@medisysdata.com/ 302-261-9187
