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AMA: 1 in 5 Medical Claims Incorrectly Processed

Greg Freeman, for HealthLeaders Media, February 2, 2011
Use this checklist to see whether you’re submitting claims efficiently

As part of its “Heal That Claim” initiative, the AMA suggests using the following checklist to determine whether your practice is submitting claims efficiently and accurately:

  • Does your practice prepare and submit claims in a timely manner? Do you update and verify patient insurance coverage and eligibility information prior to each visit to make sure that you submit eligible claims to the correct health insurer?
  • Do you have a practice staff member specifically responsible for reviewing health insurer payments for accuracy? When you receive EOBs and electronic remittance advice (ERA), do you address delays, denials, and reductions?
  • Do you keep copies of your contracted fee schedules in order to verify accurate payment from health insurers? Does your practice management software allow you to store contracted fee schedules? Do you maintain all health insurer contracts in a central and easy-to-locate file cabinet or drive?
  • Does your practice run a monthly collection report and review EOBs and ERAs for each claim?
  • Do you identify the basis for health insurer payment adjustments? Do you understand the claims adjustment reason and remark codes reported on EOBs and ERAs to explain adjustments to payments and address them quickly and appropriately?
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