How Urology Practice can be at Risk with Consistence Claim Denials?

Irregularities, errors, and incorrect CPT codes are some critical reasons, that overall physician practices, including Urology, face claim denials. It’s disappointing for Urologists providing care to a patient and expecting fair reimbursement, only to realize that your facilities’ medical billing and coding claim is being denied since the insurance payer doesn’t think the service was medically necessary.

You’re certain your revenue cycle management is up to mark in terms of claims lifecycle, or so you think. However, regardless of that, you are confronted with a decent rate of denied insurance claims. Furthermore, if not corrected in the initial stages of billing and coding can adversely affect your clinic’s rating points as well as your bottom line as your medical practice is taking a hit due to the consistence denials. So the moot question to ask here is what’s going on?

While there are a lot of reasons a healthcare insurance provider may deny your claims, but the most widely recognized billing errors are also the least difficult and simplest to rectify. As a pro hint, we would like to advise you here is that most claim denial reason continues to be patient related-registration.

Here are the top three errors in order to avoid a claim denial:

1. Wrong and incomplete patient identifier data (e.g., name spelled inaccurately; date of birth or soc. sec. number doesn’t coordinate; subscriber number and insured group number missing or invalid)

Resolution – Verify patient demographic and insurance data at every visit. Request for a photocopy of the patient’s state-issued identity proofs, such as passport, driving license, insurance card, and so on, with the goal that you are certain to have the best possible spelling, group numbers close by.

2. Check if the coverage is terminated

Resolution – Verify the insurance benefits preceding the services being rendered.

3. Procedures non-covered / require earlier approval or precertification

Resolution – Here once more, you should contact the patient’s insurance provider and affirm the coverage prior to the patient being treated. Most of the time, you will end up with furious patients if you charge a patient for non-secured charges without making them aware that they might be responsible for the charges before starting the procedures.

What Urologists and their office administrators tend to forget is it’s not about what the billing department is doing right or wrong. It might be related to the first point of contact, which is your facilities front desk. A little concentrate toward the front end of the revenue cycle management has a major effect on the final outcome and eventually the facilities ability to get full reimbursement to the services they have rendered.

With everybody on board executing the following best practices, will help you improve the registration quality and the point of service collection, and yield profitable results:

1. Keep in mind that registration is a financial function

2. Pre-enlist patient data.

3. Confirm the benefits and eligibility not less than 48 hours before the patient’s visit to the doctor.

4. Secure payments of all patient responsibility amount at the time of administration.

5. Perform quality assurance reviews on enrollment staff and procedures.

Decreasing your number of denied claims additionally requires the extraordinary ability of certified Urology billers and coders providing precision to details, accuracy, quality control, regulatory compliance, and years of industry experience. If you as a Urologist feel that your in-house billing department is falling short on reducing the claim denials, hire an expert medical billing and coding agency to do the job for you.