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There are few things in life you cannot change, but then if you are practicing as an Urologist one thing that you can definitely alter is the in-house billing and coding department. Yes, outsourcing is the name of the game, and in such if you are getting precise billing services from an offshore entity, than why not use them?

There are couple of things more disappointing than giving care to a patient, which is expecting reasonable payment in return of your services, and then getting informed that your Urology billing and coding claim is being denied in light of the fact that the payer doesn't think the administration was therapeutically necessary.

You've guaranteed your RCM process is up to speed, or so you think. However, despite everything you're confronted with a decent rate of denied insurance claims. What's more, it's starting to influence your bottom line in light of the fact that your practice reimbursement is taking a hit. So, what's going on?

While there are a lot of reasons a payer may deny your claim, the most well-known billing errors are likewise the least complex and simplest to revise. Did you know most of the claims denial reasons still relate to one of the simplest thing, which is patient registration?

Here are the top three errors and the solution to address them:

  1. Wrong patient identifier data (e.g., name spelled incorrectly; date of birth or soc. sec. number doesn't coordinate; subscriber number absent or invalid; insured group number lost or invalid)
    Solution: Verify patient demographic and coverage data at EVERY visit. Request for photocopy, i.e the patient's state-issued recognizable proof (passport, driver's license, and so on) and insurance card, with the goal that you are certain to have the proper spelling, group numbers and so on close by.
  2. Coverage has ended
    Solution: Verify coverage benefits before administrations are rendered.
  3. Non-covered services/ Requirement of prior authorization
    Solution: Here once more, you ought to contact the patient's insurance provider and affirm coverage before services being rendered. You'll end up meeting with furious clients if you bill a patient for non-covered charges without making them aware that they might be responsible of the charges before their procedure.

The doctors and their office administrators have a tendency to overlook that it's not about what the billing office is doing well or doing it entirely wrong. It might be related to the first line of interaction at the front office desk. A little concentration on the front end of Revenue cycle management has a major effect on the final product of the practice. To eliminate these minute errors urologist should always source for outsourced billing and coding agency for an amplified end result.

  1. Know that a patient registration is also a financial enrollment with you.
  2. Look for pre-enrollment data.
  3. Check eligibility and benefits no less than 48 hours before the patient's appointment.
  4. Secure payments of all patient procedure amount at the time of administration.
  5. Perform quality certification reviews on front office staff and procedures.

Lessening your number of denied claims in urology billing practice likewise requires the extraordinary ability of confirmed coders giving attention to every minute detail, demanding precision, quality control, legitimate consistence, years of industry experience and an in-depth understanding of Urology medical billing and coding nuances.

Published By - Medical Billers and Coders
Published Date - Nov-02-2016 Back

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