5 Best Practices for Improving your Hemodialysis Claim Rate

5 Best Practices for Improving your Hemodialysis Claim Rate

Hemodialysis centers rely primarily on a reimbursement mechanism with PhilHealth, and this is true for the majority of centers and patients. Return claims occur when problems arise during claim form generation, assembly and transmittal. Here are 5 best practices to help your center achieve better claim rates:

Return claims occur when problems arise during claim form generation, assembly and transmittal.

1. Ensure proper documentation and completeness of data

Good documentation starts in the treatment area. Nurses are tasked with completing treatment sheets properly and in a timely manner during the course of hemodialysis delivery. Proper charting ensures the billing staff will have all the data necessary to generate their claim forms properly. Empower your nurses to accomplish the treatment sheets and medication sheets properly to improve quality of charting and documentation.

2. Make sure no transmittal dates overlap with each other.

Overlapping claim dates can occur in multiple scenarios. The most common would be inconsistent transmittal dates resulting to claims sandwiched between claims to overlap. Another common cause of this issue would be overlapping confinement dates. Make sure to check with your patient if they were recently confined each time you generate a claim.

3. Exhausting the PhilHealth coverage limit

Depending on the most recent announcement, you may have a 90 or 144 session coverage for the year. This number decreases for each day the patient is confined and uses his PhilHealth benefit during hospitalization. Checking the patient's utilization is crucial especially during the second half of the year when most patients have already exhausted or are nearing exhaustion of benefit. Sometimes issues arise when patients check their utilization when their most recent hospitalization has not yet transmitted a claim resulting to inconsistent available benefit. Exercise caution and check with your patient frequently to avoid this error.

4. Missing key information

Another common issue would be missing key clinical data that PhilHealth has recently implemented such as height, weight, and blood pressure. Make sure to check for completeness of clinical data to avoid this issue.

5. Check for completeness of claim attachments

Billing staff should ensure all necessary claim forms and documents are attached to each claim transmittal. Common mistakes would be a missing document, documents of a different patient attached, inconsistencies in data encoded in attachments, and missing signatures. Well-trained billers, robust checking processes and redundant levels of checking can prevent these errors from occuring but require some level of experience, skill and significant resources. Consider using software that leverages technology to automate claim generation, perform completeness checks, and align data across your claim forms to further improve you hemodialysis claim rate.

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