In today’s complex world of healthcare billing, practices can make some common—yet costly—errors that lead to incorrect billing, denied claims, and lost revenue. The good news is that many of these mistakes are avoidable with some adjustments to process, approach, and training.
Mistake 1: Incorrect data on the front end. This error often involves inaccurate patient demographic/insurance information or invalid insurance coverage. The main culprit: lack of verification. The best way to avoid this type of mistake is training, training, and more training! Staff responsible for patient check-in should be educated on the importance of collecting appropriate information and verifying insurance, as well as specific steps to accomplish these tasks. (Ideally, these processes should occur before the date of service to identify potential problems early, and to ensure patients understand their fiscal responsibilities.)
Review your front-desk staff’s performance with regards to denials. If you find that there is an issue with collecting accurate demographic/insurance information, for instance, then educate the staff on how to consistently obtain accurate information.
Mistake 2: Inappropriate coding. Submitting claims successfully requires accurate coding, correct modifiers, CPT and diagnosis codes. Different payers have different requirements, and those can change often. Holding meetings once or twice a month during which your coding group discusses timely issues and new developments can be helpful in making sure everyone is up to speed on current coding requirements.
In addition, allow enough time to create the cleanest claim. This may involve taking 1-2 days after service to run the claim through the practice’s claim scrubbers, clearinghouse applications, or other tools that verify accuracy. But, by assuring a clean claim upfront, you can avoid costly reimbursement headaches from denials down the road.
Mistake 3: Not handling denials in a timely fashion. Even with the tightest upfront processes and best claim scrubbers, you’ll still have some denials. According to the American Medical Association, as many as one out of every five claims isn’t paid correctly. Don’t underestimate the importance of following up on denials. They often can be reversed on appeal; even when they aren’t, they help identify flaws in upfront processes that can be fixed to prevent further denials.
Typically, there are timely filing limits associated with appeals, so you should run denial reports daily to support quick identification and response. You may even want to set an internal deadline to start working denials – such as setting the expectation that staff work all denials within two days of notification.
Mistake 4. Not billing for services performed. This is a frequent problem regardless of whether you bill electronically or manually. To get a handle on whether your practice suffers from insufficient billing, your coding staff could perform periodic audits that compare the medical record against visit charges. Such audits can reveal whether providers are coding for office visits correctly, as well as whether they’re appropriately capturing other service charges. Randomly reviewing 10-20 charts per provider can help identify missed opportunities and display areas of improvement to discuss with providers.