No matter what the size of your practice is, mistakes are bound to happen due to human error (and other factors). With that being said, there are ways to avoid the important medical billing mistakes that could cost your medical practice substantial amounts of money. The Medical Group Management Association’s figure shows 4% claims denial rate is the ideal amount for a profitable medical group.
By following some of these pro tips, you can line up your net collection rate and increase your claims that are paid upon first submission or your first-pass resolution rate (FPRR).
Here are some mistakes you want to avoid when conducting medical billing:
1.) Claim Denials due to Misinformation – We’ve all been victim to a mistype or failure to verify insurance information from a patient. While some few and far between are to be expected, when you overlook a maximum that has been reached, or 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. Don’t be blindsided by checks when they may not be correctly reimbursing you for the full amount.
2.) Coding Errors – Is your software fully updated and integrated for codes? This is vital, especially due to the transition to ICD-10 that’s happening. Make sure your transcriptionists are up-to-date and informed on the prospective changes, and make sure the coding is processed very specifically in order to optimize reimbursement amount.
3.) Letting the A/R or aging report stack up – Not following up and resolving previous claims can be costly, and cause an office to be in disarray when a quota is not met or the allocated funds aren’t processed on time. The aging report needs to be frequently monitored to ensure it doesn’t exceed the 90-120 day mark; don’t lose out on being paid by the insurance company, finding issues and weeding them out is a continuous and arduous process, but it is necessary!
4.) Not filing claims on time – The trick here is every insurance company has a different set of guidelines and deadlines for claims. By having an EHR with ease-of-use, you can gain control of this and submit many claims electronically (with certain exceptions existing, if applicable). Keep thorough records of when you submit claims, so as to not allow payers to withhold claim amounts.
5.) Not having proper practice management or RCM – Delegating is probably one of the most important protocols in an office, and imbues trust for each staff member. Give them the proper tools in order to execute their jobs well, including software and a good system in place to process claims in between patients and other office tasks.
Tell us about your FPRR and net collection rate—is it up to speed, or could it use some work?