Medical claims are often denied because of simple, clerical billing mistakes. Even large practices with dedicated, experienced billing staff occasionally encounter denied claims due to human error and other factors. Avoiding the most significant medical billing mistakes could save your medical practice substantial amounts of money.
We’ve pulled together the five most common medical billing mistakes we see practices make time and again. By avoiding these pitfalls, you will greatly increase your first-pass resolution rate (FPRR). That means, you’ll collect more of the money owed to you, and you’ll collect it faster.
Many denied claims contain incorrect patient information. Frequently, this results from a failure to verify a patient’s insurance information or even a simple misspelling of a patient’s name. While occasional errors are to be expected, frequent sloppy work can be extremely costly. If a patient is receiving treatment for an unconventional procedure not listed on their regular insurance plan, it is always crucial to call and go over the details with the insurance company immediately before the appointment.
Is your software fully updated and integrated for codes? This is vital, especially due to the recent transition to ICD-10. Ensure that your transcriptionists are up-to-date and informed on the changes. Also, confirm that the coding is processed very specifically in order to optimize reimbursement amount. Remind your staff to always code to the maximum number of digits to avoid rejected claims.
Letting the Aging Report (A/R) Stack Up
When claims are not processed before 120 days, it becomes much more difficult to collect payment. Dealing with aging claims is time-consuming and can put an office’s finances in disarray. The aging report needs to be frequently monitored to ensure it doesn’t exceed the 90-120 day mark. Choose someone on your staff whose primary responsibility is to manage aging claims. Finding issues and weeding them out is an arduous but necessary process.
Every insurance company has a different set of guidelines and deadlines for claims. If you miss a deadline, it is almost impossible to collect payment. In order to avoid this error, you need a user-friendly Electronic Health Record (EHR) that will allow you to keep track of the various deadlines and submit many claims electronically.
Inefficient Revenue Cycle Management (RCM) Systems
A disorganized office is extremely likely to end up collecting fewer payments because of errors and oversight. Each member of your billing staff needs to be well-trained and clear on their respective responsibilities. When tasks are not clearly delegated or staff members are not trusted to do their jobs, offices run into major issues managing their revenue cycles. Give your staff the proper tools, software, and support so that they can execute their jobs well.
Looking to avoid issues with medical billing at your practice? PracticeForces can help. Our medical billing and RCM solutions can help you increase your net revenue by 20% in as little as 90 days, and our initial consultation is always free.