Medical billing is a complex process. Unfortunately, a smallest error in medical billing leads to most claims denial or delay in payment. Frequent errors can negatively impact the relationship with patients. So how to avoid medical billing denials. Read ahead to know our 10 tips to prevent medical billing denials.
Below is the denial data report from Office of the Inspector General, U.S Department of Commerce
Check the Benefits You Can Avail
A large chunk of errors can be prevented if a provider can verify the benefits at source where the patient avails a service. If a patient is a regular, it can be hard to resist using his recently entered information. However, it can lead to errors if there is a change in patient's insurance provider, the policy limit, or the terms of service. Whether the patient is newly registered or a regular, independently verify and communicate details such as authorizations, healthcare benefits, co-payment options, as well as the coverage term with the insurer. All these information plays a critical role while billing the patients without errors.
Check for Mismatch in Patient Information
Trivial errors in patient's name, gender, and birthday can be grounds for claims rejection. Should the patient be dependent on the primary insurance holder, it is even more crucial to have a matching data which includes policy and group number.
Double Check the Coding Information
Correct procedure codes and diagnosis are mandatory for the insurer to successfully reimburse the healthcare claims. The following circumstances may cause invalidation of claims - insurer makes wrong assumptions, uses incorrect codes, initiates treatment without medical necessity, and carries out the procedure without authorization. Ensure that billing staff receives appropriate training in coding tasks. It is paramount for providers to use latest coding books for reference to avoid committing expensive errors.
Create Accurate Electronic Health Records
When a medical practitioner writes a prescription in an incomprehensible way, it can result in claims being rejected. The staff responsible for billing must be trained to pose questions if they feel the codes are difficult to read. Alternatively, you can switch to automated billing systems. However, inadequate training to use the system may lead to more billing errors in EHR.
Ensure Service Is Not Billed Twice
Turn to auditing so that you need not face hassles in the future related to double billing. This is one of the common errors because furnishing bills for canceled or rescheduled procedures can magnify the chance of claims being rejected. Carrying out chart audits can help prevent errors from proliferating.
Make Sure You Furnish Complete Data
Expect denial or delay of reimbursement when you submit incomplete data to payers. Omitting the inclusion of fourth and fifth digit, or not linking diagnosis code to Healthcare Common Procedure Coding System (HCPCS) code or Current Procedural Terminology (CPT) can impact the way claims are processed. In most cases, human error is the root cause of error, but they can also be due to inaccurate diagnosis information provided by physicians.
Upcoding can be deliberate or unintentional. It is a practice where comprehensive procedure is reported which starkly varies from the actual minimalistic procedure carried out by the physician. This causes compliance issue because payers will have to reimburse providers at a higher rate. It is best to furnish accurate codes to avoid claims rejection. If this practice is discovered, it can attract stiff penalties as well as audit.
Ensure That Coders Are Aware of Bilateral Services
Bilateral services and procedures such as X-rays, vaccinations, medications etc. must be explicitly highlighted so that the coders become aware that it is inclusive of the healthcare service. When coders work at a different location from the provider, the biller will not be aware of the bilateral services if the doctor forgets to mention.
Coding Must Be Highly Specific
It is a coder's responsibility to take precaution and ensure that every code is specific because some ICD-10 codes require the last two digits to be highly accurate to avoid healthcare claims from being rejected. Whenever coders face the dilemma whether the diagnosis is accurately coded or not, it is safe to refer the codebook.
Coders Must Use the Latest Coding Manual as Reference
Outdated reference manual can significantly impact the reimbursement process. It is important for coders to attend seminars so that their coding strategy stays up-to-date and relevant to [present standards. Having latest reference manuals aid in seamless processing of healthcare claims without delay or loss in revenue. Hence, it brings relief to both patient and provider.