Common Issues Medical Billers Face: Claim Denials

One of the most important elements in your clinic is your billing since it requires protocols that start at the very first patient interaction. If front desk staff are not prepared to ask the right questions, if they do not have an organized way to get that info to the billers, and if the billers are not up-to-date on medical billing procedures, then the flawed processes can start to affect your clinic’s revenue. Here are some of the most common issues that medical billers face in their clinics:

Something as simple as a misspelled name or an invalid insurance group numbers can cause huge problems in a clinic’s billing process. Another common issue is when the information taken by the clinic does not match the health insurance’s records. When a claim is denied, it causes more work for the billers since they have to resubmit, and their entire billing system can be delayed if enough of those issues occur. This all causes the clinic a delay in revenue and increased costs. Ensure that staff who gather this important info are double checking their work.

Codes are the main identifiers when billing, so using the correct codes is vital to an effective billing process. Billers should be aware of the three major types: Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and International Classification of Diseases (ICD). The CPT codes are the most predominantly used to identify procedures performed by the healthcare providers. The HCPCS fills in the gaps of the CPT system, and the ICD codes are used to identify diagnoses. All billers should be up-to-date on these codes and receive updates and modifications on a regular basis.

When a claim has issues that causes it to be denied, it will need to be resubmitted, which could result in it being sent outside the required window of time. Another common practice is when clinics choose to set aside smaller claims in favor of larger ones. While it will allow them to get a larger revenue initially, the smaller claims still need to be submitted in a timely manner—especially since eligibility windows will vary depending on the carrier and policy. Advise the billers to work on the claims chronologically to ensure you do not have a backlog of claims.

If you address these issues and your revenue has still not recovered, then it might be time to bring in the experts. For example, outsourcing with our billing team will help you save 15% overall and maintain your over 90 days aging at no more than 10% of your overall billing. Give Outsource Receivables Inc a call to learn more.