There comes a time where you should probably stop blaming payers for medical billing mistakes, especially if your claims denial rate is higher than the 4 percent the MGMA touts as an efficient benchmark.
What does your practice’s denial rate look like? While mistakes in processes as tedious as medical billing will continue creeping up on you, there is plenty of hope for those of you wishing to eliminate headaches.[See also: Practices must surmount daily financial and regulatory challenges]
Check out the following steps you can take to prevent medical billing mistakes at your practice.
Always verify insurance
Can you guess the number one reason why most medical billing claims get denied? Not verifying insurance can cost you money and time, which is why it’s important for you and your staff to be diligent with both new and returning patients.
Contact the insurance provider to check effective dates and coverage period, assess deductibles and co-payments and check up on pre-existing condition exclusions. Every policy has its limits; being proactive can help you avoid errors when a patient’s maximum benefits are met or is receiving services not covered by plan benefits.[See also: Firm deadline fails to alleviate physicians' ICD-10 concerns]
Errors in patient information
Remember when your teachers deducted points for carelessness on school assignments? Well, seeing as hindsight is 20/20, Mrs. Kerbopple was pretty wise: University of Minnesota studies estimate that 30 to 40 percent of bills contain errors.
Simple inaccuracies can lead to billing denials, starting with patient information. Train your front office staff to help reduce these denials by familiarizing them with the patient chart, double-checking things as simple as a patient’s name, whether the diagnosis code corresponds with the procedure performed and quadruple-checking the policy number.
Denials caused as a result of these mistakes can be refilled, but expect 30 to 45 days before you receive a payment.
Implement a practice management system
Automate as much of the process as possible to reduce human errors; you can do so with a practice management system. However don’t blame the system for problems, seeing as the system won’t go as far as posting the charge and printing reports for you.
Train your staff to keep up with demands, as well as develop skills and habits within the system. A practice management system is especially useful for smaller, budget-conscious practices, who must perform more work with fewer employees. Such a system automates charge capture and entry, scrubs codes and manages staff tasks.
Errors in coding
Unbundling of codes, not entering the diagnosis code to the highest level or not understanding operative reports are anathema to getting paid. We don’t blame you, however. Given the labyrinth of codes and charges that appear on medical bills, an extra busy day at your practice can set back your payments significantly.
With ICD-10 nearly upon us, coding to the highest level of specificity is imperative, so get into the habit now. In the case of, say, diabetes, 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.
It helps to use your practice management system’s scrubber, which will signal under-coded diagnoses. Furthermore, you should facilitate a dialogue between your billers and coders to ensure the former know what truncated codes look like.
What have you done to prevent medical billing mistakes at your practice?
Ahmed Mori is a content writer specializing in meaningful use certification, EHRs and mHealth. He enjoys researching and reporting on innovative healthcare technologies. Read his work on PowerYourPractice and the CareCloud blog.