As healthcare specialists know, medical billing can be a complicated process, and the fast-paced demands can leave claims open to mistakes. However, having well-trained billers on your side helps reduce the chances of those mistakes costing you the full reimbursement. Overall, some of the most common medical issues occur due to:
Something as simple as forgetting to add the date or incorrect patient information can cause a claim to be denied. Proper standards should be in place so the front staff confirms the patient’s personal info and insurance policy numbers before an appointment.
Diagnosis and CPT Billing codes are very specific to the type of service performed, so it’s important to use the correct code when putting together a claim. Additionally, codes can be updated or expired, and application standards can be changed. It’s essential to also stay up to date on training and industry updates.
Timing is also an essential part of medical billing. A claim must be submitted in a certain period of time, otherwise it can be denied. Even if a claim is denied due to other reasons, such as incorrect patient information, it will need to be corrected and resubmitted in a timely fashion to avoid going over the due date.
The information required for a complete claim typically goes through multiple hands before the biller; scheduling, registration, eligibility, provider, coding and more. Sometimes claim submission waits on tests, procedures, or other services to be included in the submission. It’s a common mistake to miss documentation, and billers should be watching out for it as they’re submitting claims.
Denied claim versus a rejected claim.
When a claim is denied, it’s typically due to a billing error, missing information, or an issue with coverage. In many cases, it can be appealed and reprocessed through the proper steps. A rejected claim requires more immediate follow-up. A claim is typically rejected because of incorrect patient or insurance information, and they are never entered in the payer system which means they have to be reworked and resubmitted.
In general, having the proper systems and training in place will help streamline the billing process of rejections and denials, but sometimes outsourcing it to experts is the best option for your clinic. Give Outsource Receivables Inc. a call to see how we can help your specialty clinic save money and time through our guaranteed services. Clinics who partner with ORI save an average of 15% overall.