How do I make my claims easier to process?

Claim Like a Pro: Coding and Submission Tips for Medical Billing Success

Let’s talk about the nitty-gritty of coding and claim submission. This is where the rubber meets the road.

Get it right, and you’ll get paid faster. Mess it up, and your claim is taking the scenic route to nowhere…in 30 days steps…per step…ain’t nobody got time for that.

Coding Accuracy: Don’t Play the Guessing Game

Think of medical coding as the language you use to talk to insurance companies. If you’re not speaking in their brand of gibberish, don’t be surprised when your claim gets delayed/denied/ignored AKA not paid.

Coding errors are one of the top reasons for denials, so this is where you want to be extra careful.

1. Improve Coding Accuracy

The difference between a code for a minor procedure and a major surgery isn’t just a digit on a CPT code akin to a typo—it’s the difference between a paid claim and a denial.

• Use the latest codes: Medical codes change as fast as fashion trends. Keep your ICD-10, CPT, HCPCS, and modifier codes up-to-date to avoid claim rejection.

• Double-check your work: Mistakes happen, but a quick review can save you from turning a flu diagnosis into “left arm caught in airplane propeller” – yes there is an ICD 10 for that.

Pro Tip

Know your code segments. Build cheat sheets. There are 10K and 60K CPTs and ICD10s respectively…you don’t use 90% of them. So build this out. Here’s a few examples of what we’ve build for our clients! 

Pro Tip

The bots are coming…consider using not only Coding tools like AAPC Codify (link), but perhaps an AI coding tool so your coders can ask “is this right” not “what do I do next.” Coding an OPR can take 10+ minutes for complex cases…cut the human hours to the important stuff and save 75% of your time – ask us about it (CTA)

2. Streamlining Claim Submission: Speed Isn’t Everything (Accuracy Is)

Sure, you want to submit claims fast—but not at the expense of accuracy. Rushing through the process is a surefire way to make mistakes.

Best Practices for Claim Submission

• Go electronic: The days of snail mail are long gone. Submitting claims electronically not only speeds up the process but also reduces human error. If you’re still submitting on paper…you’re wasting a buck per claim and 4 weeks per check (2 to get to them and 2 to get it back)…oh and they can use the “USPS ate my homework” excuse to claim they didn’t get anything…or if you get paid, it will probably be a Virtual Credit Card so you can pay money to get paid the money you’re already owed.

• Track your claims: Once you submit, don’t just sit back and wait. Keep tabs on your claims and follow up if payment isn’t received in a reasonable time.  This means run your AR EVERY MONTH. Touch each claim and make an actionable step towards payment.

Pro Tip

Set up a system for tracking claim submissions and denials. Knowing where your claims are at any given time can save you a world of headaches. We have a nifty little spreadsheet template we built if you’d like an example.

3. Handling Denials: Don’t Give Up, Appeal

Even when you do everything right, denials happen. This is literally why our job exists folks. More denials, more time, less payments. The trick is to handle this BS  like a pro. Don’t just toss them in the “too hard” pile…don’t adjust…don’t ignore—appeal intelligently!!

Effective Appeal Strategies

• Understand the denial: Why was your claim denied? Was it a coding error or missing documentation? Pinpoint the issue so you can fix it.

• Appeal quickly: The longer you wait to appeal, the worse your chances. Get on it fast and include all the necessary documentation to support your case.  Remember the 30 day rule…every day you delay adding 30 to it…and again…ain’t nobody got time for that.

Pro Tip

Keep track of common denial reasons and fix any recurring issues in your process. If you’re always getting denied for the same thing, it’s time to adjust your approach.   Beyond that, more than two is a trend folks. Match your payers, CPTs, CARC/RARCs and denials.  Wanna get fancy? Track your success rates per appeal template. Know which methods are working. Data = power!

Tired of dealing with denied claims? Let us help! Book a call, and we’ll show you how to optimize your claim submission process.

FAQs

How do I know if my claim was denied due to a coding error?
Most insurance companies will include a reason for denial in their explanation of benefits (EOB). Look for any mentions of incorrect or incomplete coding.  Common CARC/RARC codes that drive at appeals include Bundling, MUE, Medical Necessity.

Should I hire a professional coder?
If your practice handles a high volume of claims, hiring a certified medical coder can be a game-changer. They stay up-to-date on code changes and can drastically reduce coding errors.  You can save serious dollars and reallocate labor to save more with the right team. Check out our nifty little savings calculator.

What’s the best way to track claims after submission?
Use billing software with built-in tracking or set up a manual process to follow up on outstanding claims. The key is not to let claims fall through the cracks—follow up regularly.