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Medical Billing - 10 Blunders to avoid

August 30, 2011

Since the past few years, medical practices have seen stagnancy or declining medical reimbursements especially with the continuous rise in practice costs. Most practices are unable to understand the core reasons for dipping revenues and increasing denials.

Expert billers and Coders have recently come together to find out the top 10 blunders that physician offices are making which results in denials. The most disappointing problem is that they are unaware of these mistakes and commit them regularly without any amendment.

The most common mistakes that a medical billing office can make are elaborated below:
1. Piling on Old Coding Books:

Some of the physician offices still utilize old coding books as reference material but it is not advisable. With each passing year, new CPT, HCPS as well as ICD-9 coding books should replace the older versions; if at all the office is still interested in coding with the help of books.
Most of the practices refer to codes that are available electronically, already built into their software. Codes are easily searchable and more resolutions are available on special coding software like Encoder Pro.

2. Blaming poor performance of Payers:

The relationship between insurance payers and providers is a sensitive process of the reimbursement process. Inability of Medical billers and Coders to do their part of the bargain in time and blaming Payers of stringent regulations, can sometimes make the rate of denial go higher.
At the end of the day, medical billers and coders must recognize that sinking reimbursements as well as increasing write-offs affect their practice. It would be their initiative to improve the quality of claim to get paid better.

3. Assuming the Patient is still under the same Insurance Plan:

Presumption can be a big reason for claim rejection, front office staff can not be taking it for granted that a patient is still under the same insurance plan. It is the tendency of patients to change their insurance policies. So, the billing office should confirm every single time if the patient has any new information to add to his demographic information thus saving thousands of dollars from refiling and rejection.
More importantly, physicians must ensure that their front office is not overworked to check this crucial information.

4. Not Measuring Key Performance:

Not closely monitoring key performance is a major mistake committed by physician offices. A professional practice flow knows that keeping track of Medical Billing performance is critical.
Financial Reporting or tracking key performance indicators has always been undermined which also includes days in accounts receivables outstanding, trial balance on accounts that has gone aged and other such important indicators.

5. Engaging Wrong People:

Healthcare jobs seem to be the most stable growth opportunity and thus lots of people hope to get into Medical Billing and Coding jobs, the result medical billing and coding courses are enrolling many students without marking any potential.
It is important to put stress on finding the right medical billing personnel with appropriate experience and willingness to grow. Even for the experienced Billers checking references for new recruits, verifying credentials and conducting a relevant test before deciding to hire can be a good idea. Physicians must also consider bringing the administration team together and setting good processes right in the beginning.

6. Not Verifying Patient Benefits:

As a patient’s plan changes all the time, their deductibles as well as co-pays also changes. The preauthorization of patient benefits though time consuming should be not be scraped and it is recommended that the physician office should develop a policy as well establish a time frame in order to verify the process of patient benefits.

7. Never Fully Utilizing a Practice Management System:

The way systems are developed these days, most physician offices don’t utilize them even 40% of its capacity, especially if an untrained user is operating it. Exploring the potentials of your system helps you take maximum benefit of your investment in Practice Management Systems.
Besides old, outdated management software can pose a lot of problems and engage a lot of cost in maintenance and up-gradation. So it is the duty of every physician office to have adequate knowledge, develop one’s own skills and at the same time reach out to other users in learning from them.

8. Missing on Patients’ Vital Information:

Sometimes medical billing offices make the mistake of not taking down patient’s vital information such as his/her telephone number, preferred insurance and other benefits. It is necessary to note down all of these into an encounter form since this information is bound to play a crucial role in the collections process later on.
Missing out getting a sign on some critical forms for information release and Advanced Beneficiary Notice can later impede efforts on denial management or even appeals.

9. Failure in automating:

Automation is necessary for maintaining profitability in this competitive market. With the usage of electronic health records, it has become easy to overlook the applications of various technologies. Medical Billing can be simplified physician offices work more with fewer employees, but for which a strong base in the technology is required.
Keeping up with new demands can happen only with new technology to simply and automate routine tasks. Failure in automating definitely impedes practice growth.

10. Failure in Prioritizing their Work:

With the rate of work increasing all the more, prioritizing work can become quite critical for billing offices. They have to manage a number of responsibilities such as payment posting, appealing denials, A/R receivables and so on but they will have to know how to prioritize their limited time.

Addressing many such issues is the expert billers and coders of medicalbillersandcoders.com - the large consortium of medical billers and coders. These billers have come together to be trained and grow with the healthcare fraternity, they help physicians across 50 states avoid blunders as mentioned above. With hundreds of billers available in the every specialty and having different software experience, Medicalbillersandcoders.com is here to streamline physician offices and improve collection unconditionally.

To counter all these common errors, these billers take a number of steps to ensure efficient billing including keeping themselves updated with the latest CPT codes as well as billing software, help in maintaining an amicable relationship with payers, automation and so forth. The biggest positive of these billers is that they are willing to grow and accept change as it comes. They bring along with themselves the expertise and help your current staff accommodate the best industry practices.


Category : Best Billing and Coding Practices