The control of glosses It is, without a doubt, a central step in the management of health plan operators. If done improperly, it can result in undue charges to the insurance company and harm the financial sector; on the other hand, if it is too rigid, friction may occur between the company and associated clinics or professionals. How to balance this process, after all?
This question has certainly crossed the minds of many supplementary health managers. Therefore, we have separated 3 fundamental tips to carry out your gloss control efficiently. With them, you avoid compromising your budget and, at the same time, maintain a friendly relationship with your collaborators. Ready to learn more? So, keep reading the post!
1. Empower your auditors
A few years ago, it was not uncommon for general practitioners or clinicians to be hired for general audit work. This was not entirely inappropriate; After all, the complexity of the procedures and exams was lower, as was the introduction of new technologies, giving this work a relatively lower risk.
Nowadays, that has changed. With the understanding of the seriousness of financial control in supplementary health, the medical audit took a prominent place. We already have specialties focused directly on auditing, which are often requested by health plans.
This training is essential for the doctor to understand the processes necessary for the audit. Furthermore, an experienced professional can mitigate friction with clinics or professionals in the event of a cancellation. Therefore, do not neglect this area and always trust qualified professionals for the service.
2. Use electronic medical records
Medical documents are of fundamental importance for the control of disallowances. They are the ones who define the patient's clinical condition and history, which are watersheds in some diseases. Therefore, the more you facilitate the process of collecting data from medical records, the better you will be protected in the audit process. And for this, technology can help.
Electronic medical records are already a reality in many health plans. They make it possible, for example, for the filling of objective data — such as the ICD, the patient's age and their staging — to be mandatory. This makes it easier for the auditor to differentiate cases that deserve greater attention from those that have been charged accordingly, in addition to avoiding requesting procedures or exams that have already been
performed and unnecessary at that time.
3. Count on an efficient medical billing system
When you already have the required fields filled in, screening for cases worthy of further investigation can also be automated. This is the service that a medical billing system provides, for example: guided by the protocol of the contract between the operator and the hospital, the software automatically directs cases that do not meet the necessary requirements.
This allows auditors to focus their services where they are most needed. Cases that are known to meet the requirements of the health plan are automatically approved; Those who raise any doubts automatically call the auditors, who resolve the impasse personally. This is the most efficient way to optimize your gloss control.
It is for these flags that the SAUDI, medical bill reference software, is guided. SAUDI works to bring greater transparency the relationship between the operator and service providers, facilitating the process of medical audits. The entire procedure is done digitally, even enabling mobile auditing — carried out exclusively by the smartphone.
If you want to better control disallowances for your health plan operator, medical billing software can be essential. Discover 5 reasons to use it now!
