This month’s revenue cycle management blogs explored a number of topics, including the basic concepts of a claims clearinghouse, how to ensure managed care claims flow smoothly, 3 ways to help your back office runs smoothly, and 8 ways to avoid False Claims Act pitfalls. Here are some highlights from each and links to access each blog in full.
“Clearinghouse 101” – an introduction to the some of the critical features and benefits of a claims clearinghouse. Whether you are using one today or not, take a peak. You may find some of the tips useful.
Partnering with a clearinghouse with connections to thousands of payers makes submitting claims easier and revenue moving. Keeping cash flow in a steady stream means understanding how managed care works – knowing the systems, procedures, and requirements are critical. A clearinghouse, like primeCLAIMS, has the ability to connect with multiple Managed Care payers, helps to ease the transition into Managed Care and your revenue cycling.
Interruptions, urgent requests, and unanticipated call-ins, even scheduled absences can be disruptive. But retreat is not the answer. Substitute is the better option - making sure that others are trained to cover the important aspects when needed.
Periodically, you will see settlements or court decisions rendered for False Claims Act violations. Claims may be subject to false claims accusations for treatments or services provided that are not deemed medically necessary, do not meet coverage qualifications, or medical record indicates they were not provided as ordered.