Sometimes, you are so focused on delivering the best patient care, it causes key medical billing mistakes. Whether it’s submitting paper claims, not having EOBs for all claims, not understanding denial reasons, not following up on claims, not reviewing clearinghouse reports, and the list goes on.
Unfortunately, failure to follow payer policies and reimbursement guidelines can significantly affect the practice’s bottom line. The medical billing and coding experts at Medical Billers and Coders (MBC) want you to be aware of these key medical billing mistakes and basic tips working on them.
Working on these key medical billing mistakes will ensure that your every medical service will get paid, either by the payer or by the patient.
Key Medical Billing Mistakes:
Not Using Medical Billing Software
Paper claims are outdated, nowadays everyone submits claims electronically. You can use billing software to submit claims electronically. There are lots of billing software, this billing software has multiple billing plans as per your usage.
This medical billing software offers multiple benefits like claim scrubbing, verifying patient coverage, payer enrollment, payment integration, electronic EOBs, and many others. With medical billing software, you can submit claims on a daily basis and can receive quicker payments.
Electronic claims are generally processed within a week and you will receive a payment within 10 working days. As per the claim process status, you can appeal it without any delay. You have lesser chances of running out of timely filling limits with electronic claim submissions.
If you are using medical billing software for the first time then it must be properly set up with billing experts. You have to communicate with payers that you will be submitting claims electronically with the specific clearinghouse.
Not Reading EOBs
The payer has the right to accept or deny your claims, at the same time they have to give an explanation for every processed claim. Sometimes payer might need additional documents to process your claim, sometimes it got rejected due to wrong patient/insurance information, and sometimes the patient has deductibles or co-payments.
You should be able to read every line item in EOBs. Based upon EOBs you can update payments in the system, send a patient revised invoice (for unpaid deductibles, co-pays), and appeal denied claims. Reading and interpreting EOBs (Explanation of Benefits) requires medical billing expertise.
You should be able to understand every denial reason and next line of action. Most providers due to a lack of skilled billing experts don’t pay any attention to EOBs and only focus on submitting every claim. It’s always better to confirm the payer has reimbursed for all the codes correctly.
Not Following Up on Claims
Most providers just focus on submitting every claim and won’t pay attention to denied or rejected claims. As mentioned earlier, payers are liable to provide payment feedback for submitted claims. So read the EOBs and start calling insurance for denied claims. Even if you receive a denial reason for the claim, it’s better to ask the insurance rep’s next line of action.
Some practices do not follow up on outstanding insurance claims, and these practices can leave a huge amount of money behind. Checking claims should be a continuous process. Your staff should proactively monitor aging reports to identify denied/rejected claims that need attention.
Some practices don’t run aging reports, they just notice when payments are not coming, then check on them. Those practices are losing money to claims that never get to the insurance company, claims that get denied but notice of the denial is never received, and checks that never make it to the provider’s account.
Not Checking Clearinghouse Reports
On a busy day in practice, it can be challenging to find the time to look at the clearinghouse reports, especially when unread reports start to accumulate. But if you don’t take the time to read these reports, you won’t find problem claims that require attention.
Speaking of time, the longer you wait, the less likely those problem claims will get paid. Fix and resubmit them right away. Most medical billing software has scrubbing features that highlight claims that are likely to get denied. Read the scrubbing report and edit the claims accordingly.
Not Having a Skilled Medical Billing Team
Most providers underestimate the medical billing process, some of them consider it as just a data entry process. Believe it or not, in some practices, the biller gets assigned so many other responsibilities that medical billing gets pushed to the bottom of the pile.
Handling medical billing and coding requires a deep understanding of payer billing guidelines and reimbursement policies. Medical billing and coding guidelines tend to change from time to time, staying top of these billing updates will ensure maximum reimbursements.
After patient care, medical billing must be the second most important job in your practice. After all, billing brings in revenue and provides steady cash flow to keep your office running smoothly. Billing is an intricate process that must be handled properly to ensure that an office runs efficiently.
Our medical billing and coding experts can help you in working on these key medical billing mistakes. We provide complete medical billing and coding services which include, medical coding, charge entry, payment posting, denial handling, eligibility verification, prior authorizations, accounts follow-up, provider credentialing, and other services.
Our billing and coding experts are well-versed with payer policies and reimbursement guidelines for every medical specialty. To know how we can eliminate key medical billing mistakes and improve overall practice collections, please contact us at info@medicalbillersandcoders.com / 888-357-3226
FAQs
1. Why is using medical billing software important?
Billing software streamlines claim submissions, reduces errors, and speeds up payments with features like claim scrubbing and electronic EOBs.
2. What is the significance of reading EOBs?
EOBs explain claim processing details. Understanding them helps identify issues, appeal denials, and ensure accurate payments.
3. Why should providers follow up on claims?
Following up on denied or unpaid claims prevents revenue loss and ensures timely reimbursements for submitted services.
4. How do clearinghouse reports help in medical billing?
Clearinghouse reports flag problem claims. Regularly reviewing them allows timely corrections and reduces payment delays.
5. Why is a skilled medical billing team essential?
Experienced billers ensure compliance with payer guidelines, handle claim denials, and maximize practice revenue through accurate billing.
