The Secret to Getting Paid: What You Need to Know About Facility Claims

Welcome to 33rd edition of our newsletter. The success of your claim submissions depends on correctly identifying facility charges. This article will explain everything you need to know about facility claims to ensure you get reimbursed accurately for your services.

Understanding Facility Claims

Instead of a bill, think of it as a request for payment. Your healthcare provider sends this request, called a facility claim, to your insurance company. The claim details the medical services you received at the facility, like a hospital or clinic. This helps the insurance company understand what they owe for your care.

Facility Claims: A Breakdown of Covered Services

Facility claims encompass a wide variety of healthcare services provided by hospitals, clinics, and other medical facilities. Here's a closer look at some key areas:

• Inpatient and Outpatient Care: This covers everything from routine check-ups to complex surgeries. Whether a patient stays overnight or receives same-day treatment, the services provided by the facility are included in facility claims.
• Lab Tests and Diagnostics: Any diagnostic procedures performed in a lab, from blood work to X-rays, fall under facility claims. These tests play a crucial role in diagnosis and treatment planning.
• Medical Interventions: Surgeries, specialized treatments, and other procedures performed within the facility are also part of facility claims. This category captures the core medical services offered by the institution.

It's important to note that these are just a few examples, and facility claims can cover a much broader range of services depending on the specific facility and the care provided.

Understanding Billing Types: Professional vs. Facility

Deciphering medical billing can be tricky because different types share similarities. However, grasping the key differences is crucial to avoid rejected claims and financial setbacks. Let's break down what sets professional billing apart from facility (institutional) billing.

Focus of Services:

• Professional billing: Targets fees for medical services provided by professionals like doctors and nurses.
• Facility billing: Covers broader costs associated with using the facility itself, including equipment and administrative fees.

Reimbursement:

• Professional claims: Reimbursement is based on pre-determined rates or negotiated agreements with insurers.
• Facility claims: Reimbursement might depend on the patient's diagnosis category (DRG) or other fixed payment systems.

Optimizing Revenue Cycle Management

Small Challenges, Big Impact for Medical Billing

Running a small medical practice can be tough. Keeping up with medical billing and coding accurately can be a huge burden, especially without a dedicated team. This can lead to errors and delays in getting paid for your services.

The Outsourcing Advantage

The good news is that you don't have to go it alone. Many small practices choose to outsource their medical billing and coding to a professional service like MedReven. While this might seem like a big decision, especially on a budget, there are significant benefits to consider such as:

Utilize Your Existing Staff Better

Is your staff bogged down with medical billing tasks? Outsourcing can free up your doctors' time to focus on what they do best: providing excellent patient care.

Reduce Errors and Boost Revenue

Our team of experienced medical billers, with expertise across various specialties, ensures accurate claims are submitted the first time. This minimizes lost revenue due to billing errors and keeps your practice compliant with regulations.

Save Money and Gain Predictability

Training and managing in-house billing staff can be expensive for small practices. Outsourcing offers a cost-effective solution with predictable billing costs, making it easier to manage your budget.

Partnering with MedReven allows you to focus on providing quality care while their experts handle the complexities of billing and ensure accurate reimbursements.

Schedule a free consultation with MedReven to discuss how we can streamline your Urgent Care and improve your practice's bottom line. Call us at (469) 529-1552 to learn more.