Hello, my name is Ashley Brown, and I’m the Senior Director of Operations for our revenue cycle management team located in Paddock Lake, Wisconsin. Our clients are always asking us what the secret sauce is to submitting clean claims. And the answer is simple– it’s clean intake.
We believe the best practice for clean intake is ensuring that you’re responding to your incoming referrals in a timely fashion. If there’s any delay in delivering that equipment to the patient, you’re not only keeping your patient in constant contact, but you’re also keeping your referral in constant contact.
After you receive the referral, it’s extremely important that you’re obtaining an accurate insurance verification. This would include if you’re in or out of network, what your out-of-pocket is, what the patient’s co-insurance and deductible is, if prior authorization is required, and any other payer requirements.
Once you get the payer requirements, it’s extremely important that your business understands those requirements and that they’re following them and obtaining the appropriate documentation. Then once you get that documentation, you’re going to want to take a look at that sales order. Do you have the appropriate modifiers in the places that they need to be? Do you have the appropriate claim notes that need to be submitted on the claim?
The last step is talking to your patient, letting them know that their equipment is on the way, discussing what their financial obligations are, collecting that copay upfront, or getting them enrolled in autopay. If you have a backlog in your incoming faxes or you have a large volume of health revenue, RCM services could be the answer for you.