Understanding Medical Reimbursement
Posted Tuesday, October 24, 2023Did You Know? Electronic medical billing cost around $1.60 while paper-based medical billing costs about $12 per claim processed.
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01 | Coding & Reimbursement
There are many different types of medical reimbursement, so there can be some confusion surrounding this process. Coding and submission of claims is not only tedious but also complex and requires precise information for processing. It is important that your practice has a comprehensive record and administrative team to prevent any delays or rejections with reimbursement claims.
There is a great deal of risk associated with the entire claims process in billing, coding and reimbursement. Many errors can occur from inadequate staff and lack of education in policies and laws. Services are available to help streamline and automate claims to eliminate errors quickly with secure review processes to ensure accuracy. There are also many classes and seminars that offer updates regarding coding and reimbursement.
02 | Claims Management
Claims for any insurance or program must be overseen in a very well-outlined and controlled inter-office process. Claims management should be a priority in any practice and should always be reviewed for possible enhancements or beneficial process changes. There are assessments that can provide valuable feedback and information regarding your office's current claims management. Reviewing the overall revenue cycle, inter-office capabilities and constraints will allow office management to make corrections and changes where necessary to allow for a more effective and efficient claims management process.
03 | Claim Roles
With so many roles and different parties involved in the reimbursement process, it is easy to see why human error causes the most obstacles. Depending on your practice billing model, the following are all possible roles associated with the claims process in a provider practice:
- Front End Staff — Capturing insurance data, verifying eligibility, prior authorizations, collecting co-pays, etc.
- Backend Staff — Track and resolve billing edits, submit claims, post denials, payment processing, etc.
- Providers — Capture accurate charges and conduct completion of clinical documentation.
- Clinical Staff — Obtain patient consent and waivers.
Learn More
Contact us today to learn more about the resources offered to Matrix GPO members, as well as new and exciting services available to the healthcare industry. Click here to visit the Matrix GPO website and fill out an enrollment form.
References
https://matrixgpo.com/Content/preferred-portfolio-member
https://matrixgpo.com/Content/gpo-overview
https://zipdo.co/statistics/medical-billing-industry
2026