Out of 10, every 8 medical claims are rejected because of the medical coding errors. For end number of reasons, the primary ones are physician has wrongly transposed a CPT or ICD-10 code or inserted the wrong two-digit modifier at some time or another, and insurance companies are quick to let you know you if you did something wrong.
It is critically important that you minimize any coding and processing errors when you file medical claims. Healthcare providers receive the majority of their revenue through the processing of successful claims, so any such mistake you make could cost your employer.
Medical billing and coding rules and payer requirements have become more and more detailed and restricting. The margins within which physician practices operate continue to decrease. Electronic medical records, practice management systems, and other automated tools used by practices require too much time and manual effort to use correctly. New quality and value programs are requiring more time and effort with little visible benefit to patient care or outcomes.
The health care field is in many ways no different than the broader market. As the system becomes more complex, practices have to continue to innovate, educate, and improve internal systems to keep up with both the clinical and administrative demands of the system. Like it or not, the human interface is a key component. Input into the system must be accurate, and the outcome of the automated processes must be monitored to ensure that the information is correct.
The best part is medical billing denials can be avoided. We look at the most common billing errors that are costing you valuable time and money and gives pointers on how you can achieve a clean claims submission.
Understand The Major Difference Of Rejected Claims And Denied Claims
A denied claim is one that has been determined by an insurance company which is unpayable. Typically, insurance companies explain the reasons for denying the payment for the said medical claim. There is an “Explanation of Benefits” also known as EOBs attached to the claim. Claims are often denied because of common billing errors or missing information, but can also be denied based on patient coverage. Denied claims can be appealed and reprocessed in some cases.
A rejected claim has been rejected because of errors. An insurance company might reject a claim because a medical billing specialist incorrectly input patient or insurance information. Once a medical billing specialist amends the errors on a rejected claim they can resubmit it for processing with an insurance company.
Below We Have Mentioned How You Can Reduce Your Costly Billing Mistakes:
Not Able To Get The Insurance Policy Requirements
Every insurance policy has a specific process for billing medical services for reimbursement through claims. Failing to comply with the same is a sign that increases the risk of insurance claim rejection, which in turn triggers a costly appeal and resubmission process.
Since each policy is unique, it’s imperative that you review key submission details before making a claim. The typical medical practice generally needs to set aside at least four or five hours each week for reviewing policy requirements and changes — it’s a good idea to have a single staff member function as the claims compliance person with the responsibility of staying up to date on new billing issues. There are plenty of resources to help.
It also wouldn’t hurt to have an impartial medical coding and billing expert claims to make sure there aren’t any structural problems in how you are submitting bills.
Feeding Incorrect Coding
This is another huge error which the majority of the practitioners as well as health specialists fails to perform. Medical coding errors are the number one reason why claims are rejected, accounting for eight out of every ten denials. Just about every physician has wrongly transposed a CPT or ICD-10 code or inserted the wrong two-digit modifier at some time or another and insurance companies are quick to let you know you if you did something wrong.
Reducing coding errors is a huge part of the medical billing process. With the confusing ICD, CPT or HCPCS codes and pick up any of your diagnosis code and your procedure code can go a long way toward eliminating errors. If the system is cloud-based, new billing codes and protocols will update automatically, ensuring that the practice never uses outdated codes.
The demographic information on claims is missing or incomplete. Fields such as birthdate, or a complete address, can delay the processing of a claim. Additionally; medical billing coding errors or usage of outdated codes can cause claims to be denied or delayed. All billing systems should have robust “scrubbing” software to catch common errors prior to the claim being submitted electronically.
Understanding Of The Service Coding
It requires having a better understanding of the medical service coding which is beneficial for both data input accuracy and output accuracy. For e.g. a healthcare specialist who does not care about coding accuracy may be perceived as not caring about billing accuracy. Your staff will follow your lead. Having an efficient medical billing coding software from a professional medical coding company can do wonders in eliminating the errors.
Filing Medical Claims Too Late
The majority of the insurance companies require that you submit claims within a certain number of days after the medical service. Time limits vary anything between 30 days and two years is considered normal but in every case, the clock only stops ticking when the insurance carrier receives a valid claim. If you submit a claim with incorrect information, the claim will be denied. It’s possible to fix the problem and resubmit the claim with the correct information, only now there’s a good chance the carrier will deny it for timely filing.
Outsourcing your billing to a specialist medical billing service provider can prove to be cost-effective. The value of outsourced companies lies in their ability to submit clean claims on time and thus collect a higher percentage of the billed amount.
Medical billings errors are expensive mistakes that result into reduce revenue and profits. The crucial thing is about maintaining the cash flow stems from understanding each insurance policy, keeping up to date with changes, being vigilant with data entry, and training staff in the latest codes and billing protocols. Be sure to review your billing practices and take the necessary steps that will positively impact your practice’s bottom line.