A Comprehensive Guide to Handling DME Medical Billing Payments: EFT, Cheques, & Virtual Credit Cards
You may encounter situations where the file does not support a maximum claim amount is not supported by the file because the file has not arrived at the clearinghouse. So, what do you do based on whether you filed the claim through an electronic signature or via a paper-based method?
When you work claims you will notice that there are times when the full amount of the claim is not displayed in the file because it has not yet posted to the clearinghouse. Based on the type of filing that was originally made, meaning whether it was an electronic signature or a paper claim, what is your next step?
We will go over some of the claims in which payments are already being made by the insurance companies. As you start working on a claim, you will face some scenarios where payments have already been made. You need to process such kind of payments in the system for your claim to be considered closed. It will count toward your productivity. So, let’s see the information you need to gather to process such claims.
In case a claim has been processed and paid either in electronic form through EFT or in paper, you should ensure that you follow this up by verifying the payment. In case the payment has been made electronically, you will be required to verify the date of payment. This is considered critical information to be sure that the payment jives with what was credited to the bank account of the doctor. In the case of verification, the bank statement can be checked and the transaction ID provided by the insurance company can be referred to.
Payments made by the insurance company are generally in batches; they are not for individual claims but many at a time. For example, if one has filed 20 claims and payments were expected in 15 to 20 days, a bulk payment would be issued by the insurance company, and an Explanation of Benefits (EOB) would be generated. This bulk payment has to get posted in the system to each patient. You must note the amount paid per line item and the patient’s responsibility, if any. It is critical to verify that the amount billed and the paid amount match and that the right amount is billed to the patient.
If the insurance company says it has been paid via EFT, you must get several key pieces of information. The date of payment will be cross-checked to verify whether the amount is actually credited to the bank account of the doctor. The reference number against the payment would be there on the bank statement that would match that provided by the insurance company. At the same time, the total paid amount is confirmed since the insurance companies usually pay in a bulk amount and not upon individual claim basis.
They generate a bulk statement and issue a lump sum payment, accompanied by an Explanation of Benefits (EOB).
Find out the allowed amount for each CPT code in the claim. There is a fixed amount for each service mentioned in a CPT code that an insurance company will pay. The charged amount and the allowed amount may or may not be the same.
For instance, if the service charges were for $200, but the insuring agency agreed to pay just $150, then the remaining difference of $50 is not to be waived and still stands to be payable. So, this difference has to be adjusted accordingly in the system. So, you must verify, for each line item, the allowed amount, the paid amount, and the responsibility of the patient. The patient’s responsibility can be deductibles, co-pays, or co-insurance amounts that need to be accurately calculated. Sometimes if you are doing payment via cheque you have to confirm whether the cheque was really cashed. You would need the cheque number, when it was issued, and for how much. If the cheque was not cashed, then you would need to confirm the mailing address to be sure that it was sent to the right one. Sometimes, a cheque might get sent to an old address because the facility moved, and this would require you to stop the payment and get a new cheque cut. Sometimes, the payments go directly to the patient rather than the provider. In that case, you will be supposed to obtain details for the amount paid and the patient’s outstanding balance. This way you will know how to correctly charge the patient for all remaining amounts. So you will have billed the patient right and the payment is accurately posted in the system.
Another modern method some of the insurance companies employ includes payments via virtual credit cards, where a virtual credit card will be provided to the amount that can be swiped on the clinic’s machine, or details will be keyed online. This method is supper-fast and goes away with time-consuming traditional cheque payments.
It is fast gaining popularity because of the convenience and speed at which it settles claims. It is crucial to understand these various payment modes and ensure that one posts them correctly in the system. It is handy while trying to settle claims very fast and helps maintain a seamless workflow of billing.
Some insurance companies might still pay through EFTs and cheque but would also consider using virtual credit cards. When a payment is to be made using a virtual credit card, the insurer provides information with the number, the expiration date, and the CVV number. Such information can be shared over a secure portal, or directly in the billing department. The provider accepts the card information and processes the payment, usually via their payment system, or simply through a credit card machine located in the clinic.
Virtual credit cards have emerged as a modern way of payment, both timely and swift. This medium dispenses with the time gap in case of an EFT transfer, or even cheque, for that matter. The payment can be seamlessly done through the easy process, while credits are instantly made to the vendor’s account. This mode is very advantageous when timely payment is important. During the usage of this payment method, there is need to get all the details right, which include the total payment and the amount each and every service line is allowed. Just like in the other methods of payment, the right details must be recorded for the allowed amount, the patient’s responsibility, and overpayment and made a suitable adjustment in the billing system. The responsibility of the patient is considered important as it greatly affects the last amount the patient may be liable to the provider.
The increase in the adoption of virtual credit card payments by insurance companies is indicative of this industry trend toward faster and more efficient payment solutions. This streamlines the payment process but reduces the administrative burden involved, making account receivables easier to manage. In conclusion, understanding the intricacies of the different methods of payment—EFT, cheque, virtual credit cards, and direct patient payments—is very important for correct medical billing.
Both have their own distinctness and become helpful to be given due care in being able to post the payments accurately and any discrepancies are quickly addressed. As methods continue to evolve, keeping abreast with these new techniques and the latest updates is important for someone working on medical billing and coding.
It allows an improvement in the processing of claims more effectively and guarantees that health service providers receive the payment due. You will gain expertise in managing the revenue cycle with fewer delays and optimized financial performance for DME healthcare providers through the acquisition of these skills and understanding all the ins and outs of DME medical billing. This kind of competency becomes quite significant when struggling through the many complications within healthcare payment landscapes, in assuring accurate reimbursements and on-time accuracy.
Conclusion:
If you’re looking for a DME Billing Company, Accqdata is here to help. With our expertise in handling EFTs, cheque, and virtual credit cards, we ensure efficient and accurate billing processes. Contact us today to streamline your billing operations and focus on what matters most—providing quality care.
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