Smooth Sailing: Mastering Insurance Claims With the Best Medical Billing Company in New York

Most doctors (like yourself) spend anywhere from 4-8 years in school before spending another 4-8 years completing various internships, residencies, fellowship programs, and other optional training initiatives. 

During that time, you’ll learn everything you need to know about caring for your patients – which is good, because they rely on your knowledge and expertise to help them live a happy, healthy, and normal life.

But caring for your patients is only half the battle in a community like New York City. 

While your patients always come first, being a doctor isn’t just about wanting to help people – it’s also about making sure you have the tools, resources, and equipment necessary to help when called upon. 

And in this economy, that means making sure you get paid for the services you provide. 

But there’s just one small problem, though. 

Most doctors aren’t trained in the medical billing process, and it’s not something they teach you in medical school – yet it’s the single most important thing that keeps your medical practice doing what it does best. 

If your dream job is turning into a financial nightmare, don’t panic – we can help!

Medical Billing: How Do Doctors Get Paid for Their Services? 

Unlike retail transactions, where a customer buys something in-full before leaving the store, medical bills are generally paid for weeks (sometimes months) down the line – well after the patient is taken care of. 

That payment generally comes from one of two (if not both) sources: 

• In some cases, the patient is responsible for paying the doctor for services provided.
• In other cases, the patient’s insurance provider covers the cost of medical services. 

While billing the patient is as straightforward as it gets, doctors often experience delays when invoicing patients – especially since most patients don’t have the means to cover the cost of medical bills up-front. 

And while insurance providers have more than enough money to cover those costs, they don’t make the reimbursement process easy – and filing a claim doesn’t guarantee that they’ll fork over the money. 

Unfortunately, that’s a harsh reality many New York doctors are experiencing as we speak. 

Denied vs. Rejected: What’s the Difference? 

A medical claim is a reimbursement request that typically includes a diagnosis and a series of medical codes that describe the services rendered by the clinician, including medical code(s) and billing modifiers.

Once filed, the insurance provider processes the request and delivers one of three verdicts: 

• An approval means the claim was accepted by the insurance company, and they agree to pay it. 
• A rejection means the insurance company can’t process the request due to errors or typos. 
• A denial means the insurance company reviewed the claim, but isn’t agreeing to pay it. 

Getting rejected isn’t the end of the world, since most claim rejections can be edited and sent back before receiving an updated verdict. But getting denied – that’s often the worst-case scenario for most doctors.

Once denied, the doctor has no other choice but to bill the patient directly. And while some patients will pay that expense immediately upon receipt, others can take months (even years) to cover that cost. 

Getting Approved: How to Maximize Reimbursement

Getting approved is the obvious goal when submitting an insurance claim. It’s what gets you paid in a timely manner and is often the primary source of revenue for medical and clinical practices today. 

Unfortunately, some doctors have a hard time getting their claims approved – and for various reasons. 

Credentialing issues, coverage limitations, missing referrals, incorrect patient (or insurance) information, improper medical codes and/or modifiers, duplicate claims, insufficient documentation, late filings…

There are a lot of things holding you back from getting paid on-time, but these can be avoided when you know what you’re doing – and that’s exactly what a medical billing company can do for your practice. 

With that said, here are five things you can start doing today to reduce the fear of denials and rejections. 

5. Patient Demographic Information

The medical billing process begins the moment the patient walks through your front doors for the first time – and it often includes having the patient fill out a series of documents about their identity and symptoms. 

You’ll need this information when putting together a superbill for the insurance company. 

It’s important to verify the information (name, birthday, address, etc.) before sending it to an insurance company – any errors or typos will result in a rejection, which often results in reimbursement delays. 

4. Understanding Patient Coverage

While gathering your patient’s demographic information, you’ll also have them fill out a form that details the type of insurance they have (if any) – that way, you know what is and isn’t covered under their plan.

And even if it’s covered, most providers only cover procedures that are medically necessary.  

If you can’t prove that there was a medical necessity for the services, most insurance companies will deny your reimbursement request – meaning you’ll need to send a new, separate invoice directly to the patient. 

3. Understanding Medical Codes

Medical codes are standardized alphanumeric codes used in the healthcare industry to represent specific diagnoses, procedures, medical services, and equipment utilized during the treatment of an individual. 

Insurance providers won’t even look at a superbill unless it contains medical codes. 

And even then, just having medical codes is only half the battle. Healthcare providers must also make sure those medical codes are correct and sufficient for the services provided – if not, expect further delay. 

2. Filing Insurance Claims On-Time

All insurance companies have a dedicated time limit on when claims can be submitted – most of which give healthcare providers about 90 days (three months) to file a claim after the date of the actual service. 

If submitted outside of the specified time limit, the reimbursement request will be denied. 

Timely filing begins with the date of service, not the date on which a clinician's notes are signed. In order to prevent claim denials, make sure your notes are signed as soon as possible after the date of service. 

1. Credentialing of Clinicians

Medical credentialing is the process by which healthcare providers – such as physicians, doctors, nurses, and other clinical professionals – are vetted and approved to participate in a specified insurance network. 

This process involves verifying the provider's qualifications, including their education, training, experience, and licensure, to ensure they meet the necessary standards to deliver care and file claims accordingly. 

If this process is skipped or done incorrectly, it could lead to claim denials since the healthcare provider wasn’t an approved clinician within the network – which means the patient is responsible for paying it. 

Millenium Medical Billing: The Best Medical Billing Company in New York

Is your medical practice having a hard time stabilizing cash flow? Are your insurance claims often getting denied or rejected? Is your in-house medical billing team underperforming or falling short of expectations? 

If you answered ‘yes’ to any of the questions above, then don’t worry – we’re here to save you!

Welcome to Millenium Medical Billing – the No. 1 medical billing company in New York City.

Our team of medical billing experts is at your service, and they only have one goal in mind – and that’s to maximize your reimbursements and get you paid as soon as possible, so you can focus on what matters!

‍To learn more about how we can help your practice succeed, contact our office or call us at (718) 356-1337 today!