The healthcare industry has a very critical process known as claim  submission that directly affects the revenue cycle of any provider. Here is where healthcare providers submit claims to the insurance companies  after rendering their services for reimbursement. It is the accuracy and timeliness of these submissions that make all the difference to enable  practices to get paid for services offered.

Know the needs of  individual payers. Very few payers have the same procedures for coding,  documentation, and submission timelines. Taking the time to know  payer-specific requirements is the first step in a smooth process,  avoiding errors that result in claim rejections. One of the most  important steps you can take with regard to training staff is focused on doing so on payer-specific protocols, which maximizes the accuracy of  submissions.

The third component of claim submission is proper  coding. Medical coding translates the services offered into universally  acceptable codes that an insurance company uses when processing claims.  Coding mistakes can lead to delays or, worse, denial of payment. The  risk can be lessened through using professional coders or investing in  good coding software. Regular audits will also identify common mistakes  in coding and give opportunities for continuous improvement.

Timely submission is also as vital. Most payers have a really strict timeline  for submitting claims, and late submissions result in full automatic  denials. A streamlined process for submission of claims ensures that  claims are submitted on time. A checklist will also be required to check on the completeness of all required information before submission.

In a nutshell, proper claim submission is an important requirement to  maintain a healthy revenue cycle in healthcare. Know the payer  requirements, correct coding, and appropriate submission on time reduces the possible denials and maximizes the reimbursement potential to  healthcare providers. The benefits that it delivers improve the  financial outcome; instead, also make it possible for providers to focus more on providing quality patient care.