If left unchecked, billing and coding errors can affect practice cash flow and possibly result in lost revenue. Many billing and coding errors are straightforward, but they allow insurance companies to hold up the processing of your claims and reduce your earnings.
Medical billing is a crucial process for the financial stability of any medical practice, so precision in billing and claims processing is highly vital. The primary cause of claim denials or payment delays could be even the smallest of medical billing and coding errors.
It would be best if you acknowledged that your medical coders are responsible for the success of your claims. Are your medical coders skilled, modern, and detail-oriented? If the answer is yes, you’re on the right track. If not, now is the time to train so you can do it without making mistakes.
Correct medical billing and coding can be challenging to achieve, especially for a small practice with few resources and time. Any circumstance contributing to an increase in medical billing errors needs to be detected and dealt with as soon as feasible because insurance billing is frequently the lifeblood of an organization’s income stream. That is why any healthcare practice would benefit greatly from working with an expert medical billing partner.
Validate Medical Necessity Before Treatment
The insurance policies of patients might not always cover specific therapies. Particularly in the case of dermatologists and plastic surgeons, various operations are provided that health insurance companies cannot always cover. You risk providing free services and upsetting your patients if your office does not get authorization, predetermination, or pre-certification before treatment.
Ensure the patient’s insurance will pay for the procedure to prevent a payment delay or nonpayment. Additionally, confirm that your insurance is in-network with theirs. Change the patient to the cosmetic track if insurance won’t pay the bills. Keep a close eye on the deadline as well. You don’t want a patient to pay your self-pay rate, wait for authorization, and believe they would receive reimbursement following surgery. Your method and timeframe are equally as crucial as your financial policies.
Your office saves time and ensures that your practice gets the money it is owed by validating insurance and medical necessity. Doing this eliminates the time-consuming procedure of submitting an insurance claim, receiving a denial, figuring out the cause, and hounding the payer or patient for more money.
Before Submitting Claims, Double Check
Detailed patient information is needed on medical claim forms. When multiple forms are filled out simultaneously at your workplace, the numbers, addresses, and names tend to blend. With many forms, entering the incorrect ID number, leaving a field blank, or mixing up the birthdate is simple.
One of the most frequent justifications for claim denial is the absence or incorrectness of information. Your team will have to work extra hours, and payment delays will be prolonged because of a simple error in the patient ID number. Little, irrelevant pieces of data can bring on denials.
Make it possible for your office to submit finished claims confidently. To ensure correctness, request the employee who completed the documentation to review it again. To reduce rejections brought on by erroneous ID numbers, perform eligibility checks.
Numerous medical billing software programs can verify claims before submission if your practice has accuracy issues. Hire a medical billing business specializing in clean claims submission for a more individualized and focused approach.
Confirm With The Insurance Company Before Appointments!
Correcting a claim sent to the incorrect insurance provider might take weeks or even months.
The claim may be sent to the incorrect agency if the receptionist neglects to make a complete copy of the insurance card (front and back) or if your office staff doesn’t carefully read the instructions when filling out the form.
Ensure your reception staff correctly input the information from the insurance card’s front and back into the system to avoid this outcome. Even though claims are now sent electronically, the card’s back is still important. For follow-up, departmental phone numbers can be helpful.
Maintain A File Of All Submitted Claims
The submission of duplicate claims there is another frequent billing problem. If your office mistakenly files two claims, the second one will be rejected.
Confusion may result from the denied claim, mainly if your staff is unaware that two claims were made. Indicate the claim type. Take note of previous claim numbers. Don’t just send the same information again and over.
Invest in a claim submission tracking records management system. Your workers can validate claim submissions and eliminate duplicate claims by keeping the data up to date.
Insurance companies also reject suspected duplicate claims when they believe they can justify them or when they are too similar to another claim. Your office can lower the amount of potential duplicate denials by correctly categorizing the claim with the appropriate modifiers for the condition or therapy.
Examine Coding Guidelines
Many contend that inaccurate or vague coding is to blame for denials. Coding practices are constantly evolving. Even many seasoned medical professionals err when relying solely on memory.
Review all current coding practices and keep up with updates. A list of current coding processes with changes can be found on the CDC website.
Claims codes should always be as specific as feasible. For incredibly similar diagnoses, there are numerous coding variations. Have an ICD-10 reference handy to be sure you’re using the correct code. Claim denial rates are significantly reduced when coding quality is improved.
Send In Claims As Soon As Possible
Denials of late claims are frequent. Even though a claim is comprehensive and factual, it could still be rejected if it is not submitted on time.
The claim-submission window for Medicare is one calendar year after the service date. All subsequent assertions are refuted or refused. The submission deadline for claims has an expiration date that varies in length for all well-known insurance providers.
Establish a schedule for claim submission to prevent late submission of claims. For instance, each claim has to be submitted no later than a month after service. The claims from the previous week or month could even be finished at a weekly meeting.
Consider hiring a medical billing company as an outsourcing option if your clinic has trouble submitting claims on time. They care for every aspect of billing and coding for your clinic, freeing you to concentrate on the people who matter most: your patients.
Train Your Staff In Medical Coding
The insurer must check the correct procedure codes and the diagnosis details to reimburse the medical claims correctly. The invalidation of claims is caused by incorrect codes and the beginning of treatment without a medical necessity.
Your practice will be assisted in preventing medical billing errors by an experienced team. They will keep track of the various codes for diagnosis, outpatient procedures, and medical procedures, helping you to lower claim denials. Therefore, it is essential to guarantee that the billing personnel has the necessary training in coding activities.
Utilize Cutting-Edge Medical Billing Programs
Your practice may benefit from using modern, innovative medical billing program to complete the medical billing coding procedure efficiently and error-free. Before sending the claim to the insurer, the best billing software identifies inaccurate information and checks that there are no coding problems.
Therefore, employing medical billing program will result in fewer denied and pending claims, saving your administrative team’s time. To reduce the likelihood of further billing issues, confirm with your employees that they are knowledgeable about the system before selecting the billing software for your business.
Watch Out For Unintentional Up- Or Under-Coding
Upcoding and under-coding, both prohibited and could lead to penalties or criminal charges, are frequently done to benefit a practice financially. Upcoding is adding codes to a patient’s bill for services that were not rendered; this is sometimes done to increase the overall amount owing to a provider. Under-coding occurs when codes are omitted from a patient’s bill, frequently to evade an audit.
However, there are instances where this might also occur unintentionally and not on purpose. This is typical for anyone who lacks medical billing and coding experience, feels overburdened by the volume of claims they’re managing, or hasn’t kept up with the most recent developments in the sector.
Submit Medical Claims By The Deadline
It isn’t much you can do if claims are late if they are submitted after the deadline. The most challenging denials to appeal are those for timely submission.
Maintaining a running list of the most frequent ones required and assigning time-critical responsibilities to your personnel to audit unfiled claims are two ways to ensure you don’t miss these deadlines. A calendar event or regular reminder can be a valuable solution to this issue.
Cooperate With An Experienced Medical Biller
By establishing a reliable and effective procedure for handling insurance claims, medical billers are responsible for maintaining the financial stability of practices. It’s not an easy job. Medical billers face challenges, such as denying or dealing with disputed claims. When you manage billing and revenue cycle management on your own or delegate it to your staff, you increase workplace stress and raise the risk of medical billing errors, which could lead to lost revenue.
You can reduce claim denials by employing a team of skilled medical billers and coders who can efficiently keep track of hundreds of medical codes, diagnoses, and treatments. Additionally, your staff will no longer have to spend time resolving billing difficulties, freeing up more time for patient care.
A group of qualified medical billing and coding specialists is on hand at Practolytics. Regardless of how big or small your practice is, we can help because we are the industry’s top provider of medical billing and RCM solutions. Utilizing market-leading technology, Practolytics will provide you the freedom to concentrate on patient care while fostering financial success. We can help you find lost revenue, immediate payment past dues, and shorten the time it takes to manage your accounts receivable by outsourcing all billing and coding to us.
Conclusion
Hospitals should prevent medical billing and coding errors to minimize reimbursement concerns. Regular continuing education courses, lunch-and-learns, and other informal training events can help ensure that your staff members are up to date on the most current coding standards and best practices.
Correct and insufficient information are among the numerous common causes for claims to be returned to the supplier. A slight finger slip might result in significant time and financial loss and postpone the appeals process. Use the most recent reference materials and train your employees to prevent medical billing and coding mistakes.
