MOS Medical Record Review Company’s Post

Outlook: The global healthcare claims management market size was valued at USD 21.64 billion in 2021 and is expected to grow at a compound annual growth rate (CAGR) of 23.4% from 2022 to 2030. Health insurance claims management in India has traditionally been a complex and time-consuming process. Manual handling of claims, coupled with the intricacies of verifying medical documents and assessing eligibility, often leads to delays and errors. Our outlook on the market opportunity, on medical insurance claim management, is bullish as it solves a ubiquitous and widely acknowledged challenge: offering convenience and efficient mediclaim management at a time when the insured along with family members are going through a hospitalization event. Our portfolio firm ClaimBuddy creates value for itself, for its customers and for all its business stakeholders by providing claim assistance and management services during Medical events which are always difficult periods for patients who need to focus on their recovery and well-being. For more details on our investment themes and industry POV visit us at: https://lnkd.in/gwz3nF4c #dominor #familyoffice #medicalinsuranceclaims #claimmanagement #claimbuddy #healthinsuranceclaims #privatemarketfund #privateequity #directinvestment #privatemarketinvestment #earlystagecapital #venturecapital #investmentthemes #healthinsuranceclaimmanagement

Why Insurance Verification Matters? Insurance verification is a critical process in the healthcare industry. It ensures that healthcare providers receive timely payments and that patients understand their financial responsibilities before receiving care. This process, while often time-consuming, can significantly improve the efficiency of billing, reduce claim denials, and enhance the patient experience. Its essential for several reasons such as below: #Financial Transparency: Verifying insurance helps clarify what costs are covered by insurance and what portion may be the patient’s responsibility. This transparency avoids unexpected bills and improves patient satisfaction. #Timely Payments: When insurance details are verified in advance, it reduces the likelihood of claims being denied or delayed, enabling providers to get paid more quickly and accurately. #Reduced Denials: A substantial percentage of denied claims occur due to eligibility issues. By conducting thorough insurance verification, providers can avoid these denials and cut down on costly rework and appeals. #Healthcare #Insuranceverification #Benefitverification #RCM #Revenuecyclemanagement #Chargeentry #ARcalling #Accountsreceivable #Costoptimisation #Revenueenhancement #Outsource

20 years on the health insurance side of the industry has taught me this: Practices that spend more than 3 hours per day on denial reconciliation are (a) working claims 1 at a time, (b) aren’t prepared to adapt to industry changes & events, and (c) inadvertently create about 35% of their denials. -------------------------------------- For every payer, denials are applied in 1 of 3 stages of the claim processing system - Intake, Coding Review, and/or Clinical Review. Knowing where the denial was created informs how it needs to be resolved. (BTW - it rarely ever requires calling customer service.) #DenialManagement #ProviderReimbursement #HealthcareBilling

Periodic claims review is an essential process in medical insurance that helps insurers manage costs, ensure the accuracy of claims, and maintain the integrity of policy coverage. Let’s see how it benefits both the insurer and the policyholders: 1. Prevention of Fraud and Abuse: By regularly reviewing claims, insurers can identify suspicious patterns or fraudulent activity, such as excessive billing or unnecessary procedures, which helps reduce costs and keeps premiums affordable. 2. Cost Control: Claims review helps insurance companies control costs by ensuring that the medical services billed are necessary and fall within the policy’s scope. This review prevents overpayment or payments for non-covered services. 3. Ensures Accurate Payouts: Periodic reviews ensure that only eligible claims are paid out. This protects the insurer’s financial health and ensures funds are available for legitimate claims, benefiting policyholders who need their coverage. 4. Improved Policy Compliance: Claims review ensures that claims align with policy terms and conditions, helping both the insurer and policyholder stay compliant with the policy’s coverage rules. 5. Informed Policy Adjustments: Reviewing claims data helps insurers identify trends, like new common treatments or changes in healthcare costs, allowing them to adjust premiums, deductibles, and coverage terms to reflect current needs accurately. 6. Better Risk Assessment: By analyzing claims patterns, insurers gain insights into risk factors associated with different groups or demographics. This data helps refine underwriting practices, potentially leading to more tailored, fairer premiums for policyholders. Overall, periodic claims reviews help ensure sustainability and efficiency in health insurance, which leads to better, more reliable coverage for everyone. #healthinsuranceclaims #policyperformance #lossratio #asnic

“Show me the incentive and I will show you the outcome.” — Charlie Munger Imagine a Medical Insurance world where we all opt out of large insurance PPO networks and save 20%-35% on all medical claims. Referenced Based Pricing (RBP) is that solution. Now Imagine a RBP partner who does not design their system charging you fees buried and hidden in your self funded claims account as a percentage of Facility Billed Charges. As my favorite corporate executive, Charlie stated so wisely, RBP vendors who charge their fees as a percentage of Facility Billed charges will maximize their fees at your peril. We are at an Ah-Ha moment in US Health Insurance and I recommend you do not pick a RBP partner who designed their fee structure that allows them to influence their RBP fee outcomes. There are multiple RBP vendors with better ways America! Design your product and service correct, and I will show you the best outcome. #ERISA #FIDUCIARY #CFO #COSTCONTAINMENT #RBP #REFERENCEDBASEDPRICING #ASO

Navigating the complexities of insurance verification can be a daunting and time-consuming task for many healthcare providers. Ensuring accurate and timely insurance verification is crucial to prevent claim rejections and delays, which can significantly impact your practice’s cash flow and patient satisfaction. At Medheave, we specialize in streamlining the insurance verification process to help you focus on what matters most—patient care. Here are a few tips to make the process more efficient: ✅ Automate the Verification Process: Utilize technology to automate insurance verification, reducing manual errors and saving time. ✅ Verify in Advance: Verify insurance details before patient appointments to address any issues upfront. ✅ Stay Updated: Keep up with the latest insurance policies and guidelines to avoid outdated information causing rejections. ✅ Clear Communication: Ensure clear communication with patients about their coverage and any out-of-pocket expenses. By partnering with Medheave, you gain access to our expertise and advanced tools designed to streamline your billing processes. We handle the intricacies of insurance verification, ensuring accuracy and efficiency, so you can minimize rejections and focus on delivering excellent patient care. #MedicalBilling #InsuranceVerification #HealthcareFinance #RevenueCycleManagement #Medheave #HealthcareAdministration #PatientCare #BillingEfficiency #HealthcareProviders

Good Insurance Authorizations: 1. Streamlined processes for efficiency. 2. Clear communication with insurers. 3. Accurate documentation. 😊 Bad Insurance Authorizations: 1. Delayed responses. 2. Incomplete paperwork. 3. Miscommunication. Save time & reduce stress by adopting best practices! Contact us for a free consultation. Share your thoughts or experiences below! 📞 Visit us at https://lnkd.in/gB4rkqsj for more info. #Insurance #Healthcare #Efficiency #MedicalBilling #HealthcareBilling #RevenueCycleManagement #MedicalPractice #ClaimProcessing #BillingSolutions #HealthcareFinance #MedicalCoding #BillingExperts #PracticeManagement #HealthcareRevenue #BillingEfficiency #PatientCare #MedicalClaims #DenialManagement #HealthcareCompliance #BillingSupport #MedicalBillingServices #BillingAutomation #HealthcareSolutions

Insurance verification can be a tedious process, but with the right software, you can streamline workflows, reduce claim denials, and enable your practice to focus more on patient care. Check out our latest blog to explore the Top 7 Insurance Verification Solutions of 2025 and learn how these tools can transform your practice.  https://lnkd.in/gjivGVGc #insuranceverification #healthcaretech #patientexperience #revenuecyclemanagement #CERTIFYHealth