In some recent studies, it has been observed that healthcare claims have risen by 3.5 times in the year 2021. This also pushed the healthcare insurance premiums to shoot up. As people are becoming much more aware of healthcare insurance benefits, healthcare insurance services are also growing. One of the most important changes that are taking place is in the space of insurance claims management.
This article will take you through the different factors affecting insurance claims management, the significance of this service, and the other related details.
What is insurance claims management in the healthcare sector?
Insurance claims management in the healthcare sector refers to managing the insurance claims made by a patient/ on behalf of a patient at the hospital. However, claims management is not just about processing the claim. Multiple steps are involved in insurance claims management in the healthcare sector. The process includes organizing medical claims, billing related to the treatments, filling the claim forms, updating the bills in case of periodical treatments, and processing the claims.
Furthermore, in the healthcare sector, the urgency of processing the claims is very high. So, there is a need for professional insurance claims management services for efficiently handling the claims and facilitating the process within a short turnaround time for both the healthcare service provider and the patient. This is one of the reasons why many hospitals outsource the insurance claims management work to firms that are specialized in providing these services. Another important reason for outsourcing claim management is to cut down the expenses associated with maintaining an internal team.
Why healthcare insurance claim management is the need of the hour?
Multiple factors affect insurance claims management in the healthcare sector because of which its significance is growing. Some of the important factors are listed below.
- The rising cost of medical treatments: The cost of medical check-ups, treatments, and medications is drastically increasing. Apart from an inflationary rise in the prices, the overall prices are increasing owing to a shortage of drugs, better medical facilities, experienced doctors, and other such factors. The costs associated with medical treatments are also rising due to the high demand for better quality treatment and also innovative and alternative treatment options. However, the most important factor responsible for the increase in prices is the surge in chronic diseases, such as cancer, among the population.
- Efficiency in claims management: Since the number of patients are constantly increasing, and people opting for healthcare insurance policies are also on the rise, it is becoming increasingly important for hospitals to engage with Insurance Back-office Management Services to assist them with the complete management of the insurance claims. Processing of the insurance claims needs to begin as soon as the patient is admitted to the hospital, and thus, there is an urgency associated with claims management. This quick turnaround time involved with claims management is the main reason why healthcare services must have a dedicated team of professionals taking care of all the insurance claims.
- Better communication: When a patient is admitted, the family members may not be in a good state of mind to handle any issues regarding insurance claims. It is in such a situation that the healthcare services must have people on board who are experienced in handling healthcare claims and processing them easily without disturbing the patient’s family.
Steps involved in insurance claims management
Insurance claims management involves the steps described below.
First, billing of all the medical services that have been rendered to the insured party is carried out. There are multiple expenses like medicines, bed charges, doctor’s fees, equipment, and other charges. It is important to include every expenditure accurately, and hence, a person with experience in the field is required.
Next comes organizing and maintaining the records of all the bills and details of the patient. This includes prescriptions, medical bills, lab-test reports, and other documents, which the patient needs to produce for claiming the insurance from the insurer.
An efficient claims management service will help the patient handle the insurance claim procedures with minimal stress during such a traumatic period. Once the patient submits the insurance documents, the claims management department should contact the insurer and submit the necessary bills, reports, prescriptions, and other documents to receive the sum assured on time.
An important criteria is that the claims management team has to protect the privacy of the patient and not disclose any personal information to any third party.
With the rising number of insurance claims in the healthcare sector, insurance claims management has become an essential service in the industry. Though the complete digitization of the claims management process is picking up speed, it has a long path ahead.