As EMS billing and reimbursement evolves, it’s important to review and update your processes regularly. Claim narratives were a standard practice for years, but are they really necessary anymore?
I have been involved in healthcare reimbursement for over 25 years. I can remember when claims were printed on duplicate carbon forms from a dot matrix printer. We had to tear off the edges, fold each claim, stuff it into an envelope to mail, and keep a copy before electronic claims filing and cloud storage were an option. These days, everything is electronic. From eligibility to claims submission to document storage. So, it begs the question, has your process changed?
Most claims are uploaded into an electronic clearinghouse where they are sent to the payor. The claims editing system reads the information and makes a coverage decision based on an algorithm. Unless it’s a high dollar claim or some other unique circumstance, the claim will likely never see human intervention before a coverage decision is made.
I often encounter clients who still write a narrative for each claim they send, regardless of the payer. This can be very time-consuming with very little payoff of the time investment. The well-crafted claim narrative is not read by the payer most of the time. That begs the question, why is it still being done? The answer I hear most often is “We’ve always done it that way”. That can be a dangerous mindset when reimbursement and time management are critical to the success or failure of a billing process.
If we want our billers and coders to reach peak effectiveness in their roles, we must remove every possible antiquated process that does not offer a tangible dividend on the time invested in performing the function. Claim narratives were a requirement many years ago but in the digital age, they’re no longer required on every claim anymore.
