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Too Many Rejected Claims?

Every practice battles denied claims. Sometimes it seems easier to push claims through and worry about it when they bounce back but that actually takes longer, is more of a hassle and delays revenue.

Rejected ClaimsNothing is easy – that’s for sure. But, recently I read this article that was a nice reminder of five things that can be done to avoid denied claims and all the back-end work that comes with them. One and done!

Billing is a complex and often tedious procedure, especially with the latest ICD-10 codes. However, many returned or delayed claims are often the results of not following some of the basics. Below are some of the most common billing mistakes we see practices make and how you can avoid them.

1. Transposing information will lead to Big Headaches

Quite often reimbursements are delayed or denied because of very small, easy-to-make mistakes. Many times we find that a front office or provider will transpose the numbers and/or letters from the policy number or omit a group number or even the plan ID. The front desk staff is typically busy from the time their day starts until the time it ends. However, this attention to detail will save the many hours of frustration and eliminate the headache of having to resubmit claims.

2. Have you included all your documentation?

Payers will delay payment because you didn’t send enough information. A good example is when you file workers’ compensation claims. Documentation to submit with the claim is a must! An easy rule of thumb is keep in mind that if you know documentation will be needed to receive reimbursement for your claim, then submit it up front to avoid delays.

3. Ask First

This is incredibly easy, but is a costly mistake if you do not request prior authorization. Always, always, always, before you perform any procedures, verify whether or not a prior authorization is required. The prior authorization is required; place the request before scheduling the procedure. And when you bill for the procedure, make sure the authorization number is on the claim. This will save time and prevent payment delays.

4. Take a second look

In today’s world, claims are increasingly being denied because the patient’s coverage has been terminated or the plan or payer has changed.  More and more people change insurance plans much more often than they used to.

Ask to see the patient’s insurance card at each office visit. And perform a verification of benefits if the patient hasn’t visited you in a while. It’s a simple strategy to avoid claim denials due to a terminated policy.

5. The world of medical billing is constantly changing

Even if policies haven’t changed, a patient’s coverage or what is no longer covered can change. Don’t be left holding the bag if a payer changes its policies about what procedures they cover or what labs they use, and you don’t know about it. Most payers send out updates via email or their web portals notifying providers of these changes.It can be extremely difficult to stay up to date on these changes. A good revenue cycle management company will often employ a credentialing team that can assist with staying up to date on these types of changes.

Many times large practices employ administrators who keep an eye out for these changes. However, a smaller practice might not have the adequate resources to do. And may times the responsibility falls on the front office staff or in house biller. Just be sure that whoever’s responsibility it is understands the importance of carefully reviewing payor bulletins when they are released.

We would be pleased to talk to you about how we can help you improve your billing processes or handle them for you. To start a conversation, please contact Rick Knutzen at (888) 745-1926 or by email to rknutzen@optimalrcms.com.

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