In this episode, we talk about errors in the processing of insurance claims. We start by examining the staggering 19.3% error rate reported by the American Medical Association, with a focus on underpaid claims. Through real-life examples, we uncover instances where insurance companies downgrade procedures, leading to significant financial losses for healthcare providers. We discuss strategies for detecting these errors, including thorough insurance verification processes and the utilization of preauthorizations. Despite the complexities, we explore potential solutions, such as legislative measures and proactive approaches like preauthorizing treatments to ensure accurate reimbursement and minimize administrative burdens.
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Time stamps
- 00:01:10 – How often do insurance companies make mistakes with processing claims?
- 00:05:36 – Can you be specific and explain what kind of mistakes you see insurance plans make?
- 00:10:01 – How would one know if there is a mistake that insurance made?
- 00:15:07 – What solutions can you think of that would allow practices to detect claims processing errors?
- 00:20:07 – Who do you recommend that can help a practice audit everything from claims processing errors to coding/billing opportunities?
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