How to File a Medicare Claim That's Accepted the First Time

Even though 15% of the population in the U.S. are enrolled in Medicare, many medical billers are still having a hard time figuring out how to successfully file a Medicare claim. There are a lot of details to keep track of, and if you don’t, it is very easy for your claim to be rejected. Don’t worry, everyone has a hard time with this. Here are some tips on how you can most successfully file a Medicare claim that is sure to be accepted the first time.

Tips To Help Your Revenue Cycle & Breakdown Silos

Don’t let yourself become overwhelmed. Taking a few steps to assess your agency’s revenue cycle management process can help improve your acceptance rate. Here are our tips:

1. Assigning claim processing roles appropriately amongst staff.

The way that your team handles claims processing needs to be thoroughly thought out and organized. The different duties should be assigned to separate groups who are already skilled in these areas and are most likely to do the job well. A well-organized team should look something like this:
Intake Staff Responsibilities:

  • Gather insurance information
  • Verify enrollment dates
  • Watch out for PEPs, Hospice, MSP, and HMO overlaps
  • Ensure Face to Face is done

Back-end Staff

  • Ensure billing amounts are accurate
  • Monitor billing edits
  • Ensure claims are submitted in a timely fashion
  • Perform follow-ups for outstanding balances
  • Post and resolve all rejections daily
  • Ensure payment amounts are accurate
  • Give feedback to intake on their process

Providers

  • Ensure billing software is updated and accurate
  • Complete treatment documentation in a timely manner
  • QA all notes including PT, OT, ST, SN, HHA, & MSW

Management

  • Eliminate silos among departments
  • Monitor communication between each team
  • Monitor overall staff and departmental productivity
  • Review the revenue cycle quarterly and determine changes that need to happen

2. Automate As Much As Possible

By using a real-time homecare software, you will be supplying your staff with tools that will help them complete documentation seamlessly and reduce costly billing mistakes. Both intake and back office procedures will become streamlined, such as:

  • Intake
  • Scheduling
  • Orders Management
  • Billing
  • Workflow
  • Documentation
  • CMS compliance

3. Be Aware Of Changes

Medicare change their policies, annually. When this occurs, the codes change as well. If your staff is not keeping an eye on this they could be submitting claims they believe to be accurate only to receive a rejection. To keep on top of these changes your team should subscribe to newsletters, listservs and attend conferences. Hold monthly debriefs for individuals to communicate to the rest of the team when they learn anything that could be considered an important detail not to be missed.

Turning To The Experts

Intake and billing can become overwhelming fast. If you are billing in-house, you most likely need a team of people with the experience of different qualifications, skills, and knowledge in order to successfully file claims.
If your office is struggling to keep a healthy revenue cycle, it would be wise to consider outsourcing your medical billing or consulting with experts in this area. By doing so, you can save money on overhead costs and reduce risk of errors that lead to rejected and unpaid claims.
There is no doubt that you need all of your claims to be approved in order to adequately manage your business, so make the move that is going to ensure approval. Contact us here to learn more information about intake and medical billing and how outsourcing could be the right move for you.