Most of us work in busy offices where things can get lost in the shuffle and mistakes are made. But by identifying the most common mistakes, many errors can be avoided, which saves practices both time and money.
By avoiding these top seven billing and coding mistakes often made in the medical or billing office, you can increase revenue and prevent denied and lost medical insurance claims.
Mistake #1: Not photocopying ID cards regularly
The office policy really needs to be that the staff gets photocopies of all insurance cards. If the patient says he doesn’t have it with him, then the staff needs to stress the importance of bringing it to the next visit, even if the patient says no information has changed.
Blue Cross often changes prefixes on cards and sometimes alters the whole ID number, but patients often do not notice and tell the office staff that nothing changed. Some patients don’t truly understand their insurance.
The ID card contains important information that the patient may not understand but could be important for billing. Photocopying the front and back of the cards every six months – or at least yearly – will help prevent billing problems.
Mistake #2: Not having a system for filing claims in a timely manner
If there isn’t a set plan for getting the billing done, often it gets pushed aside. It is important that claims are filed on schedule. Most payers have a timely filing limit, and some are as little as 30 days from the date of service. Miss that deadline and the claim may be denied.
In that case, appealing that denial as close to the service date as possible gives you a better chance of collecting. In any case, filing claims in a timely manner is very important to keeping a good cash flow.
Mistake #3: Not having a basic knowledge of coding
You don’t have to have a certificate in coding to bill insurance claims, but you do need a basic idea of how coding works. The person who is doing the actual coding should either be the person who diagnosed the patient or someone who reads the notes of the doctor and is capable of choosing proper CPT and diagnosis codes.
The biller cannot possibly know what the provider did unless they are reading the notes and are qualified to choose the codes. If she doesn’t have a basic understanding of coding, she won’t be able to recognize if there is a problem.
Mistake #4: Not understanding how to read an EOB
It takes some experience to be able to read EOBs to understand what is being paid for, why a claim wasn’t paid or if it was paid correctly. The insurance might have paid something but not nearly as much as you were expecting. You need to be able to figure out what the EOB says and ask someone how to fix it if it wasn’t paid properly.
It is a huge mistake to just take what is on the check as a payment in full without knowing if all codes were paid for and if they were paid correctly.
Mistake #5: Not running aging reports or following up on claims
It is truly amazing to me how many medical offices do not follow up on outstanding insurance claims. A huge amount of money is lost in those offices and often the doctor never knows.
There are always claims to check up on. Running a 30-day aging report can tell you a lot, but I’ve talked to people who don’t run aging reports – they just notice when payments aren’t coming in, then check on them.
That’s crazy. Those practices are losing money to claims that never get to the insurance company, claims that get denied but notice of the denial is never received, and checks that never make it to the doctor’s checking account. It can amount to a serious sum of money.
Mistake #6: Not reviewing clearinghouse reports
On busy days in a billing office it can be difficult to find time to look at the clearinghouse reports, especially if there is a week or more worth of them to look over. But if you don’t take the time to read these reports, you don’t find the problem claims that require attention.
Fixing problem claims definitely isn’t the fun part of a biller’s day, anyway, so it is easy to overlook this step. But the longer you wait, the less likely those problem claims are to get paid. They need to be fixed and resubmitted right away.
As with the aging reports, we hear about many offices who “don’t have time to bother” with the clearinghouse reports. Again, that is a huge mistake.
Mistake #7: Not making the billing the most important job in the office… for the biller
This may sound ridiculous to some of you, but believe it or not, in some offices the biller is also loaded up with so many other responsibilities that the billing gets pushed to the bottom of the pile.
Next to treating the patients, billing should be the most important job in your practice. After all, it is what brings in the revenue that keeps the office running. Time after time we see offices that are struggling, and most often it is because the billing is not taken seriously enough. In order to keep the office running and pay the bills, the billing must be considered to be the most important job in the office – at least to the biller.
By just identifying which of these mistakes are a problem and putting systems in place to correct them, an office can greatly improve its cash flow. Billing is a very intricate process and must be handled properly to ensure that an office runs efficiently.
By making sure your billing system is running the best it can, you will eliminate many headaches and stress. It is worth the effort.
What mistakes are happening in your billing department?
Alice Scott and Michele Redmond are medical billing experts, co-owners of Solutions Medical Billing Inc in Rome, N Y., and coauthors of 14 books on medical billing and medical credentialing. This mother-and-daughter team maintains two medical billing websites, a free newsletter and an active forum. Alice and Michele are on the editorial staff of BC Advantage and are regular contributors to the magazine. Their books are available at www.medicalbillinglive.com