5 Admin Tasks That Can Be Lucrative To Your Practice
If you’re a provider who participates with health insurance, this is for you. There are practical, administrative ways to improve revenue in your practice—without adding more patients or extending hours. During my time at an Acupuncture clinic, I learned how to reduce denials and partial payments and streamline the reimbursement process. I’m here to share them with you, so simply read along!
Dealing with insurance companies can feel like a drawn-out, back-and-forth process. You submit a claim, wait weeks, and finally receive an Explanation of Benefits (EOB) explaining why payment was partial—or denied altogether. To make matters worse, the Contractual Adjustment prohibits providers from billing the patient for the unpaid balance. Frustrating… I get it.
Below are 5 essential steps to take before and/or after treating a patient to help minimize issues and maximize reimbursement.
1. Verify Benefits & Eligibility
This is arguably the most important step. Verifying coverage before treatment can prevent billing surprises and reduce time spent chasing payments later. Some key questions to confirm: Are you in-network with the patient’s plan? Does the plan cover your services? Is there a deductible, and if so, has it been met? Does the patient have secondary insurance? Are there visit limits or dollar caps?
2. Obtain Pre-Authorization (When Required)
Even if a service is covered, it may still require prior approval. Skipping this step can lead to automatic denials. The process is usually straightforward—submit a request that includes diagnosis and procedure codes, along with relevant patient and provider information.
3. Properly Submit Claims
Duh. I mean, did I really have to mention Claim Submissions as one of the five steps?? Yes, and I’ll explain why. Submitting a claim isn’t enough—it needs to be accurate. Use appropriate ICD and CPT codes that are payable, include correct modifiers codes, and when required, ensure documentation supports medical necessity. Small coding errors can lead to delays or denials, so accuracy matters.
4. Review EOB’s/Remittance Advice
When a claim is denied or underpaid, the EOB explains why. Review it closely to identify errors or missing information. In many cases, a corrected claim can resolve the issue. If the explanation is unclear, call the insurance company—getting clarification can save time and prevent repeat mistakes!
5. Submit An Appeal (If Necessary)
Even after you’ve sent a corrected claim, an insurance company can still decide to uphold their initial decision and refuse payment. Perhaps they’ve determined that the treatment isn’t “medically necessary.” You can choose to go beyond a corrected claim and dispute the denial by submitting an appeal. While not a guarantee of payment, appeals still give you a chance to present clinical justification and supporting documentation, which may likely sway the denial into an approval.
After reading all of this, I’m sure you’re probably thinking to yourself, “I don’t have the time to do those things”. Well, my suggestion to you is to read this blog post and determine whether or not you need some assistance!
“The more you learn, the more you earn.”
