While billing mistakes are a common occurrence, if you’re above a 4% denial rate, the MGMA thinks it’s time to reconsider your billing strategy.
Manual errors, input oversights, and/or coding issues are normally at the root of costly claim denials. Practice management software keeps an eye on these issues for you and can tighten up your billing approach so you can lower the number of denials.
1. Always Verify Insurance
Can you guess the number one reason why most medical billing claims get denied? Not verifying the correct insurance information.
Speak to your staff about the importance of being thorough when signing in both new and returning patients. Contact the insurance provider to verify effective dates and coverage periods, and calculate deductibles and copayments.
Quality practice management software allows you to check patient eligibility status electronically prior to an appointment and can even check insurance eligibility for you.
2. Errors in Patient Information
According to a University of Minnesota study, 30% to 40% of bills contain errors.
Since it only takes one simple patient error to cause a frustrating billing denial, train your front billing staff to familiarize themselves with the patient chart.
Double-check basic insertions like patient name, policy number, and whether the diagnosis code corresponds with the procedure performed. Denials caused as a result of these mistakes can be resubmitted, but anticipate a 30-to-45 day delay period.
3. Claim Automation
As mentioned earlier, a practice management system can automate much of the billing process and leave less room for human error. However, don’t rely solely on the system, seeing as it won’t post charge and printing reports for you.
Train your staff to keep up with demands by developing habits within the system. A practice management system is especially useful for independent, budget-conscious practices, which have to perform more work with fewer resources.
4. Errors in Coding
Unbundling of codes and not entering the diagnosis code to the highest level are the enemy to getting paid. With ICD-10 around the corner, coding to the highest degree of specificity is essential, so we suggest you get in the practice of detailed coding now.
With diabetes, for example, you must use a fifth digit to specify the variation: 250.00 for diabetes mellitus type two, 250.01 for mellitus type one, and 250.02 for diabetes mellitus type one uncontrolled. Note: PM system should include code scrubber functionality, which will signal you if you’re under-coding diagnoses.
Ultimately, the best denial prevention technique is quality communication between your billers and coders to ensure the former know what erroneous codes look like.
By identifying which of these tips work best for your practice, a medical office can greatly improve its cash flow. Since billing is a very intricate process and must be handled with care, make sure your billing system is running the best it can.
It is worth taking the time to correct any issues which may be impeding the billing process to eliminate the anxiety that comes with missed payments.
A version of this article was originally published on our sister site, Power Your Practice. Click here to read the original story.
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