Home Health - 2012 Claim and Reimbursement Strategies

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With the New Year here it is essential to analyze practices and procedures to ensure your home health and/or hospice agency is receiving the maximum reimbursement.  It is vital to each organization to ensure specific best practice policies are in place to reduce denials and increase claim turn-around time.  How you handle claims within your organization has an impact on both direct and indirect costs.

Most efficient claim strategies:

• Ensure agency bills out RAP claims daily
• Respond to any Medical Record request as soon as possible
• Confirm claim file delivery with each submission
• Perform a clinical audit government paid charts prior to billing
• Review each line on Explanation of Benefits for payer errors
• Correct denied claims and send out as soon as possible
• Improve work load and flow of claims review process internally based on complexity of claims

Proper management of insurance claims is required to effectively supervise the whole process, to detect fraudulent activities and to enhance the faith and confidence of policy holders in the working of the company.  A critical part of the claims management process is the ability to monitor and improve the business activity associated with processes.

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