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    6 tips to navigating the insurance game

     

     

    6. Stay involved

    I know exactly how insurance is billed at my office. Is that the best use of my time?

    This is how we get paid, so I think staying involved is a good idea right now when our patient load is smaller.

    Staying involved is also effective in making sure that as a practice we set things up correctly. I have watched countless YouTube videos about CMS 1500 forms and how to fill them out, how to read explanation of payment forms, and clearinghouse-specific training.

    Related: Defining success: Is more better?

    I know how our practice management system interfaces with our clearinghouse, and often I send the claims myself. In the setup period, it is critical to be attuned to the details.

    Even if your practice is well-established, it is important to spot check claims and ensure that they are completed correctly not only to ensure your revenue stream is what it should be but also to guard against potential audit concerns.

    Related: Behind the scenes of Instagram practice photos

    In addition, staying involved helps me to know which commercial carriers are excluding us from specific panels without telling us. (Sometimes PPO or HMO panels require a primary-care referral first or require your participation on that specific sub-panel).

    There is no shortcut to setting up your office for the first time on insurance panels. The process is time consuming and at times maddening. Some of the companies we are now regularly taking payments from took six to eight months to credential us.

    This is a marathon, not a sprint. Don’t take no for an answer. Fight the good fight. 

    Read more from Dr. Denton here

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