As a senior executive consultant in radiology, David Kent Joslin has many years of experience working with various healthcare services, software development, and management consulting. David Kent Joslin is also a board member of InSight Radiology, Puerto Rico, a multi-site operator of free-standing radiology facilities. With his extensive portfolio in the healthcare industry, he explains the healthcare reimbursement process.
Log the Patient Information Necessary to Submit for Payment
According to David Joslin, before they can get paid, medical providers have to log the patient’s information into an electronic health record (EHR). The purpose of the EHR is to document the necessary patient information including, medical history and reason for the visit. Most providers also document how they diagnosed the patient and the treatment plan. It’s necessary that the provider documents all of this information since it’s key to process the reimbursement.
Enter the Appropriate Medical Codes
Every single entry made in the EHR has to have the appropriate medical code. Medical coders or the providers are in charge of assigning medical codes. The use of these medical codes is necessary when trying to obtain reimbursement from payers. David Joslin explains that it’s a lot easier for insurance companies to simply look at the medical code instead of reading through a long medical description. For each service or procedure performed, the provider will be paid based on the services.
Submission of the Claim
David Joslin explains once the services provided to the patient have been properly coded, it’s time to submit the claim. Many providers choose to submit the claim directly to the payer/insurance company, while others first run it through Clearinghouse. According to David Joslin, the purpose of Clearinghouse is to review the claims internally before sending it to providers. If it identifies a mistake, the provider has the opportunity to address it before the payer receives the claim. This cuts back on mistakes and speeds up the reimbursement process. Once the claim is ready to go, the payer will receive the electronic submission.
Wait for the Payer’s Response
Once the payer receives and reviews the invoice, they either pay the full claim, partially pay it, or reject the claim. David Joslin says that providers should also expect a list of remittance advice codes with every rejected claim. On top of providing a code with each rejection, they also provide a brief explanation. The provider needs to take the necessary steps to give the payer what they need in order to process the claim.
Prepare for Audits
Providers should always have all of the documentation necessary in case of an audit. David Joslin explains payers can request an audit at any point to ensure all of the claims are correct. The more organized they are on the front end, the easier the audits will go.
About David Kent Joslin
David Kent Joslin obtained his MBA in finance and accounting from Columbia Business School and a Bachelor of Arts in History and Political Science from Duke University. He also holds a real estate license in the state of New York. When he is not playing a game of golf, he likes to spend time with his family in their Sarasota home.