Empirically, insurance companies will delay or deny claims payments! They are very slow on medical reviews, predetermination and processing claims. I think, that is one of their business strategies in doing business. They are too is running their own business’ revenues. But if you are a good medical biller, you are aggressive and can effectively collect payments in less than the time your provider expects.



Having an effective office manager in your practice that knows the administrative task is very important. As a provider, you should be more focused on your patients’ care and not on how you run your practice. Your patients must know their benefits and eligibility. Encourage your patients to contact their insurance company regarding their unpaid claims. The insurance is more attentive when the member makes the phone follow up.

As a medical biller myself, I can collect Medicare payments by “paper billing" in less than 2 weeks!, you can imagine the electronic claims submission. I refuse denial and rejection, because I believe, if the medical service have been rendered, it is just right to have it get paid. Many of my provider clients just give up, but, well, I don’t. As long as he wants his payments, I never give up collecting his money.. at the end, we were successfully got paid. It is just a matter of how you deal with the insurance and aggressive follow-ups.

Medical claims should be submitted on a daily basis. Never delay claims submission. Promptly respond “immediately" to insurance letters that you receive, if they require additional documents, such as, medical referral, medical prescription, progress notes and letter of medical necessity to process the claims. Always comply what they require to expedite processing of the claims.

As a medical biller, you should also be a medical coder. The doctor gives the diagnosis description on the script but usually always with the wrong diagnosis code. It is not their concern to code a diagnosis, but to descriptively provide the diagnosis. You must know how to analyze and help your provider submit the right diagnosis code. Analyzing the proper and right diagnosis code is also very effective to get paid. Remember that when submitting your claims, the insurance company does not read your diagnosis’ description. They process claims based on the right procedure codes and based on medical necessity (diagnosis code) Right procedure, service and supplies coding is also very essential in submitting your claims (CPT/HCPCS, Modifier Codes). There are procedures that the insurance denies for payment because it is NOT medically necessary based on the diagnosis on the patient. You should understand each insurance company’s payment/fees guidelines.

But here’s the thing, “if" the insurance company still keep on denying your claims, then it’s time for them to get notified, they will be reported for non-payment of claims to the proper agencies/bureaus if they don’t process your claims in 15 days!. I think, this time they will be more attentive.

Now, here is another issue, you should choose a medical billing company that will help you do all this. It is going to be a big decision that you have to make. But here are the things that you have to consider in making that decision:

(1) Able to handle accounts regardless of the medical practice account’s size

(2) Electronic & Paper Billing Capability with fast-turn around time

(3) Experienced in analyzing proper procedure and diagnosis coding

(4) Lesser claims rejection/denial. Efficient in filing of appeals for denied claims

(5) Knows how to submit claims on worker’s compensation and “no-fault"

(6) Unlimited client support and able to provide full service medical billing

(7) and the most important thing, they strictly understand, follow and comply with HIPAA guidelines, rules and regulations.