Billing and coding errors disrupt practice cash flow and can even cause lost revenue if allowed to run unchecked. Many billing and coding errors are simple, but nevertheless allow insurance companies to delay claims processing and stifle your revenue. from processing your claims.
These simple, avoidable mistakes cost your practice time and money. Instead of focusing on patients, office staff must scour paperwork for the mistake, negotiate with insurance carriers on the phone, resubmit information…call again…call again…resubmit again...and so on. At the end of this process, it takes weeks (even months) for your practice to receive money owed. The whole game is to make obtaining payment as painful as possible so you drop it.
This comprehensive guide provides experienced medical billers’ top tips to avoid medical billing and coding errors.
1. Verify Medical Necessity Before Treatment - Who’s paying?
Some treatments are not covered by patients’ insurance plans. Dermatologists and plastic surgeons, in particularly, offer many procedures that health insurance plans may not always cover. If your office does not seek authorization/pre-determination/pre-certification before treatment, you risk offering pro bono services and/or upsetting your patients.
To avoid a delay of payment or worse, nonpayment, verify that the patient's insurance covers the procedure. Also verify that you are in-network for their insurance. If insurance will not cover the costs, flip the patient to the cosmetic track. Keep a careful eye on the timeline too. You don’t want a patient paying your self-pay rate…waiting on an authorization…and thinking they get a refund after surgery. Your financial policies are just as important as your process and timeline.
By verifying insurance and medical necessity, your office saves time and guarantees that your practice receives moneys owed. This eliminates the lengthy process of filing the insurance claim, receiving a denial, determining the reason, and hounding the payer/patient for additional payment.
2. Double Check Claims Before Submission - Claims Scrubbing!
Medical claims forms require lots of patient information. If your office completes many forms at the same time, the numbers, addresses, and names start to run together. With so many forms, it’s easy to leave a field blank, confuse the birth date, or write the wrong ID number.
Missing and inaccurate information is one of the most pervasive reasons for claim denial. One simple mistake in the patient ID number creates hours of additional work for your staff and long payment delays. Simple items of irrelevant data can be all it takes to cause denials (e.g., referring provider NPI, leaving a group number blank when it doesn’t exist - Free Hot Tip - enter “none.”
Develop a reliable claim completion and submission system in your office. After an employee completes a form, have them (or a different employee) double check the form to ensure accuracy. Run eligibility checks to reduce denials for bad ID/Group numbers.
Keep an eye on your ANSI coding as well. HICF1500 boxes correlate to loops and segments, but not 1:1. Knowing the ANSI mapping in your billing systems and being 100% certain you are mapping fields properly can prevent systemic issues.
If your practice struggles with accuracy, many medical billing softwares proof claims for submission. For a more personal and targeted solution, hire a medical billing company that specializes in clean claims submission.
3. Confirm Insurance Company Before Appointments - Get a copy of the card!
Sending a claim to the wrong insurance company takes weeks - even months - to rectify.
When the receptionist forgets to take a full copy of the insurance card (front and back) or your office staff neglects to pay close attention when completing the form, the claim can be sent to the wrong agency.
To prevent this outcome, ensure that your receptionists take front and back copies of the insurance card and properly upload this information into the system. Just because claims get sent electronically now, doesn’t mean the back of the card is irrelevant. Departmental phone numbers can be valuable in follow up.
When completing claims, ask your office staff to reference the uploaded information, even if this takes extra time. It’s better to spend a couple minutes verifying information than a couple weeks negotiating the denial.
4. Keep A Record Of Submitted Claims
Another common billing issue involves submitting duplicate (or suspected duplicate) claims. If your office accidentally submits duplicate claims, the second claim will be denied.
The denied claim can cause confusion, especially if your office does not realize two claims were submitted. Use claim type indicators. Reference past claim numbers. Don’t just repeatedly send the same data.
Invest in a records management system that tracks claim submission. By maintaining and actively updating the records, your employees can verify claim submissions and eliminate duplicate claims.
Insurance agencies also deny suspected duplicate claims because they are too similar to another claim…or when they think they can justify it. By properly coding the claim with the specific modifiers for the disease or treatment, your office can reduce the number of suspected duplicate denials.
5. Review Coding Procedures
Many claim denials stem from incorrect or unspecific coding. Coding procedures are constantly changing. Even many experienced medical staff members make mistakes when relying on their memory.
Review all current coding procedures and stay up to date with changes. The CDC’s website has a list of current code procedures with updates.
Remember, claims codes must be as specific as possible. There are many code variations for extremely similar diagnoses. Keep an ICD-10 reference on-hand to confirm the correct code. Improving coding quality drastically decreases claim denial rates.
6. File Claims In a Timely Manner
Late claims are often subject to denials. Even if claims information is complete and accurate, it may be denied if not filed in a timely manner.
For Medicare, the claim-submittal period is one calendar year from the date of service. All later claims are denied or rejected. Likewise, all popular insurance companies have an expiration date of varying lengths for claim submission.
To avoid filing claims late, devise a schedule for claim submission. For example, each claim must be filed no later than a month from the date of service. You could even have a weekly meeting to complete the claims from the previous week or month.
If your practice struggles to file claims promptly, consider outsourcing to a medical billing company. They handle every aspect of your practice’s billing and coding, leaving you free to focus on what really matters: your patients.
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