Billing Mistakes and How to Avoid Them

What if a medical billing expert knocked on your door and told you and your staff how to avoid several of the most common billing mistakes? Knock knock! As the owner of a medical billing practice, I have just that gift for you. For the past 12 years, we have received calls for everything from account cleanups to posting or full-service billing, and that has given us the opportunity and advantage to see billing trends, billing mistakes, and billing successes across the country. I think you will be surprised about how simple some of these mistakes can be to avoid. Here are several frequent mistakes we see various kinds of medical practices make: Failure to Verify Insurance A large portion of claim denials or rejections are caused by not verifying patient’s insurance prior to delivery. Verifying the insurance reduces claim denials and rejections. During the verification process you can identify important factors that will help to get the claim processed correctly, such as: Coordination of benefits, and which plan is primary Prior authorization requirements Service limitations and exclusions Medical policy for the service Aside from getting claims paid the first time, it will also save your staff the administrative burden of scrambling against the clock of timely filing to gather this information after the claim has been denied. Missing or Incorrect Claim Information When we are cleaning up a new client’s accounts receivable, these denials usually have easy fixes if we receive the information within the timely filing range. Every denial takes administrative time to research and fix and as we all know, time is money. These denials can be hard to swallow because they can delay payment by 20 to 30 days for highly preventable reasons. A quick double-check of information on the claim can prevent every one of these denials. Some examples that we see are: The diagnosis code is not coded to the highest level of specificity Incorrect patient demographics Missing or incorrect modifiers Not Knowing the Coding Regulations Unfortunately, just because you purchased the componentry, made the leg, and the patient came to your office with a prescription does not validate payment. Pressing the button to send the claim to the clearinghouse is not difficult, however, knowing coding regulations is the more challenging part—the fun part for some of us—and it must be updated regularly. We cannot just educate our staff once on a particular policy; offering continuous education and training in policy, procedures, and regulations is vital to maintain the health of your billing department and your cash flow. To avoid costly write-offs, continuing education about coding regulations should be a constant target for anyone in your practice that handles coding and/or billing. Some resources for ongoing education are: PDAC regulations and coding LCD updates Reviewing quarterly denials to learn not to repeat the same mistakes Reviewing the company’s top payers’ updates and policy updates Eliminating common billing mistakes boils down to education and training. Well-trained staff in your billing and coding department can help keep your revenue cycle running smoothly and maintain steady cash flow. Erin Cammarata is president and owner of CBS Medical Billing and Consulting. She can be contacted at erin@cbsmedicalbilling.com .

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